Group Safeguard Insurance Annexure 3 UIN

Group Safeguard Insurance Annexure 3 UIN - ICIPAGP21400V032021 CIN - L67200MH2000PLC129408

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GROUP SAFEGUARD INSURANCE

PART II OF THE POLICY SCHEDULE

I. GENERAL DEFINITIONS

Certain words are used in the policy and this Policy Schedule, which have a specific meaning and are shown

below. They have this meaning wherever they appear in the Policy. Where the context so permits, references

to the singular shall also include references to the plural and references to the male gender shall also include

references to the female gender, and vice versa in both cases.

1. Accident means sudden, unforeseen and involuntary event caused by external, visible and violent means.

2. Adventure Sport means sports/activities including but not limited to Sky Diving, Bungee Jumping, Bungee swoop, Bungee slingshot, Dune sliding, Hot air ballooning, Bridge Swinging, Zip Lining, Zip Trekking, Rock Climbing, Bicycle Polo, Bamboo rafting, Rock Scrambling, Rappelling, Via Ferrata, Fell Running, Fell Walking, Gorge Walking, Indoor Rock Climbing, Mountain Biking, Mountaineering, Body Boarding, Sailing, Ski boarding, Scuba Diving, Snorkeling, Shark Diving, Sky Diving, Swimming with Dolphins, Banana boating/donuts/inflatable’s behind power boat Diving with Whales, Wakeboarding, Surfing, Auto (car) racing, Motor rallying, Motorcycle racing, Air racing, Kart racing, Boat racing, Hovercraft racing, Lawn mower racing, Snowmobile racing, Zorbing, and Truck racing Bodies or organizations conducting any such adventure sports must be recognized and licensed by Government authorities.

3. Age means the completed years on last birthday as per the English calendar calculated on the day of inception of cover under the Policy.

4. Air Ambulance means a specially equipped aircraft, typically a helicopter, which is equipped with life saving medications, CPR equipments, cardiac monitoring unit and qualified EMS personnel, used to transport injured people to Hospital in an emergency.

5. Ambulance Charges means transportation costs incurred by the insured person towards availing ambulance services from the site of Accident to the nearest Hospital or from the site of first treatment to the nearest higher center of care in case of life threatening emergency conditions.

6. Ambulance Services means procedures that are used to provide immediate care and support to transfer the patient from the pick-up point/location to the nearest Hospital where necessary treatment/care can be initiated depending on the nature of Illness or disorder, presence, severity and cause of disease.

7. ALS Ambulance means an ambulance in which Advanced Life Support (ALS) is provided in situations where the patient being transported is in a more critical condition and a paramedic is required to assist in the treatment of the patient before and/or during transport to the emergency facility.

8. Assault means any unlawful use of force inflicted by an individual(s) upon an Insured Person that is a criminal offence in the jurisdiction in which it occurs and which results in Injury to the Insured Person.

9. AYUSH Hospital is a healthcare facility wherein medical/surgical/para-surgical treatment procedures and interventions are carried out by AYUSH Medical Practitioner(s) comprising of any of the following: a. Central or State Government AYUSH Hospital; or b. Teaching hospital attached to AYUSH College recognized by the Central Government/Central Council of Indian Medicine/Central Council for Homeopathy; or c. AYUSH Hospital, standalone or co-located with in-patient healthcare facility of any recognized system of medicine, registered with the local authorities, wherever applicable, and is under the supervision of a qualified registered AYUSH Medical Practitioner and must comply with all the following criterion:

i. Having at least 5 in-patient beds; ii. Having qualified AYUSH Medical Practitioner in charge round the clock; iii. Having dedicated AYUSH therapy sections as required and/or has equipped operation theatre where surgical procedures are to be carried out;


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iv. Maintaining daily records of the patients and making them accessible to the insurance company’s authorized representative.

10. BLS Ambulance means an ambulance in which Basic Life Support (BLS) is provided in an emergency by certified Emergency Medical Technicians (EMTs).

11. Cashless facility means a facility extended by the insurer to the insured where the payments, of the costs of treatment undergone by the insured in accordance with the policy terms and conditions, are directly made to the network provider by the insurer to the extent pre-authorization is approved.

12. Child means dependent child/children including adopted and step child/children of the Insured Person up to the age of twenty five (25) years and dependent on the insured person for maintenance and financial support.

13. Coma means a state of unconsciousness with no reaction or response to external stimuli or internal needs. This diagnosis must be supported by evidence of all of the following:

i. no response to external stimuli continuously for at least 96 hours;

ii. life support measures are necessary to sustain life; and

iii. permanent neurological deficit which must be assessed at least 30 days after the onset of the coma

The condition has to be confirmed by a specialist medical practitioner. Coma resulting directly from alcohol or drug abuse is excluded.

14. Condition Precedent means a policy term or condition upon which the Insurer's liability under the policy is conditional upon.

15. Common Carrier shall mean any commercial public airline, railway, bus transport, or water borne vessel (which shall include ocean going and / or coastal vessels and / or vessels engaged for official or personal purposes), taxi services or any other mode of transport operating under license issued by the appropriate authority for transportation of passengers and / or cargo and / or any other vehicle licensed to carry fare paying passengers.

16. Deductible means a cost sharing requirement under a health insurance policy that provides that the insurer will not be liable for a specified rupee amount in case of indemnity policies and for a specified number of days/hours in case of hospital cash policies, which will apply before any benefits are payable by the insurer. A deductible does not reduce the Sum Insured. Deductible shall be applicable per year, per life or per event as stated in the policy certificate and specific benefit based deductible shall be applied if specified in the policy certificate.

17. Emergency Care means management for an illness or injury which results in symptoms which occur suddenly and unexpectedly, and requires immediate care by a medical practitioner to prevent death or serious long term impairment of the insured person’s health

18. EMI or EMI Amount means and includes the amount of monthly payment required to repay the principal amount of Loan and interest by the Insured Person as set forth in the amortization chart. For the purpose of claim settlement against any coverage under this Policy the amortization schedule prepared by the financier as on the loan disbursal date or risk inception date (whichever is later) shall be considered wherever applicable.

19. Family Member means an Insured Person's legally wedded spouse, children, ward, step or adopted children, parents, stepparents , mother in law, father in law, children in law, legal guardian, siblings, and siblings in law

20. Franchise means a per Insured event provision in the policy whereby the insurer will not pay unless damage (or loss) exceeds the specified number of days/hours/months as defined in the Policy Certificate. Once a franchise is met, the Sum Insured subject to the Benefit is payable as per terms and conditions.


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Illustration: If the customer opts for a Franchise of two days and he is admitted in a hospital for one day the benefit shall not be triggered. However, if the customer is hospitalized for more than two days the customer shall be entitled for a benefit for all days of hospitalization (up to the sum insured).

21. Grace Period means the specified period of time immediately following the premium due date during which a payment can be made to renew or continue a policy in force without loss of continuity benefits such as waiting periods and coverage of pre-existing diseases. Coverage is not available for the period for which no premium is received.

22. Healthcare Service Provider Agreement means an agreement prescribing the terms and conditions of services which may be rendered to the holders of health insurance policies of Insurance company and may be entered into between:

a. Service provider and an insurer; or b. Service provider, a TPA and the insurer

23. Hospital means any institution established for in-patient care and day care treatment of illness and/or injuries and which has been registered as a hospital with the local authorities under the Clinical Establishments (Registration and Regulations) Act 2010 or under enactments specified under the Schedule of Section 56(1) of the said Act OR complies with all minimum criteria as under:

i. Has qualified nursing staff under its employment round the clock; ii. Has at least 10 in-patient beds, in those towns having a population of less than 10,00,000 and

15 inpatient beds in all other places; iii. Has qualified medical practitioner(s) in charge round the clock; iv. Has a fully equipped operation theatre of its own where surgical procedures are carried out; v. Maintains daily records of patients and will make these accessible to the Insurance Company's

authorized personnel. 24. Hospitalization means admission in a Hospital for a minimum period of 24 consecutive ‘In-patient Care’

hours except for specified procedures/ treatments, where such admission could be for a period of less than 24 consecutive hours.

25. Illness means a sickness or disease or pathological condition leading to the impairment of normal physiological function and requires medical treatment.

Acute condition - is a disease, illness or injury that is likely to respond quickly to treatment which aims to return the person to his or her state of health immediately before suffering the disease/illness/injury which leads to full recovery. Chronic condition - A chronic condition is defined as a disease, illness, or Injury that has one or more of the following characteristics a) It needs ongoing or long-term monitoring through consultations, examinations, checkups,

and / or tests b) it needs ongoing or long-term control or relief of symptoms c) it requires rehabilitation for the patient or for the patient to be specially trained to cope with

it d) it continues indefinitely e) It recurs or is likely to recur.

26. Immediate Family Member means spouse, children, step or adopted children, brother(s), sister(s) and parent(s) or stepparents of the Insured Person.

27. Acute condition - is a disease, illness or injury that is likely to respond quickly to treatment which aims to return the person to his or her state of health immediately before suffering the disease/illness/injury which leads to full recovery.

28. Chronic condition - A chronic condition is defined as a disease, illness, or Injury that has one or more of the following characteristics

f) It needs ongoing or long-term monitoring through consultations, examinations, checkups, and / or tests

g) it needs ongoing or long-term control or relief of symptoms


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h) it requires rehabilitation for the patient or for the patient to be specially trained to cope with it

i) it continues indefinitely j) It recurs or is likely to recur.

29. Intensive Care Unit: means an identified section, ward or wing of a hospital which is under the constant supervision of a dedicated medical practitioner(s), and which is specially equipped for the continuous monitoring and treatment of patients who are in a critical condition, or require life support facilities and where the level of care and supervision is considerably more sophisticated and intensive than in the ordinary and other wards.

30. Injury means accidental physical bodily harm excluding illness or disease solely and directly caused by external, violent, visible and evident means which is verified and certified by a Medical Practitioner.

31. Insured Event means any event specifically mentioned in the Policy Certificate as covered under this Policy for which premium is received by the Company.

32. Insured Person(s) means the persons named as insured persons in the Policy Schedule who are insured for the applicable Benefits under this Policy.

33. Loan means the sum of money lent at an interest or otherwise to the Insured Person by any bank/financial institution as identified by the Loan Account Number specified in the Policy Certificate or certified in writing by the bank/financial institution.

34. Medical Expenses means those expenses that an Insured Person has necessarily and actually incurred for medical treatment on account of Illness or Accident on the advice of a Medical Practitioner, as long as these are no more than would have been payable if the Insured Person had not been insured and no more than other hospitals or doctors in the same locality would have charged for the same medical treatment.

35. Medical Practitioner is a person who holds a valid registration from Medical Council of any State or Medical Council of India or Council for Indian Medicine or for Homeopathy set up by the Government of India or a State Government and is thereby entitled to practice medicine within its jurisdiction; and is acting within its scope and jurisdiction of license. The term Medical Practitioner would include physician, specialist, anesthetist and surgeon but would exclude the Insured Person and his/her Family Members.

36. Medically Necessary Treatment means any treatment, tests, medication, or stay in hospital or part of a stay in hospital which:

i. is required for the medical management of the illness or injury suffered by the insured ii. must not exceed the level of care necessary to provide safe, adequate and appropriate

medical care in scope, duration, or intensity; iii. must have been prescribed by a medical practitioner; iv. must conform to the professional standards widely accepted in international medical practice

or by the medical community in India. 37. Migration means, the right accorded to health insurance policyholders (including all members under

family cover and members of group health insurance policy), to transfer the credit gained for pre-existing conditions and time bound exclusions, with the same insurer

38. Network Provider means Hospitals or health care providers enlisted by an insurer, TPA or jointly by an insurer and TPA to provide medical services to an insured by a Cashless Facility.

39. Nominee means the person(s) nominated by the Insured Person to receive the Benefits payable under this Policy on death.

40. Notification of Claim means the process of intimating a claim to the insurer or TPA through any of the recognized modes of communication.

41. Permanent Total Disablement means any of the following: i. Total and irrevocable loss of sight in both eyes, or ii. Total and irrevocable physical separation of two entire hands or two entire feet, or iii. Total and irrevocable loss of one entire hand and one entire foot, or iv. Total and irrevocable loss of sight of one eye and physical separation of one entire hand or

physical separation of one entire foot, or Total and irrevocable loss of use of two hands or two feet, or


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v. Total and irrevocable loss of use of one hand and one foot, or vi. Total and irrevocable loss of sight of one eye and loss of use of one hand or one foot.

For the purpose of this definition: i. Physical separation of a hand or foot means separation of the hand at or above the wrist,

and of the foot at or above the ankle. ii. Loss of use or Loss of sight means total paralysis of one or more limb, or loss of vision

respectively, which is certified in writing by a Medical Practitioner to be permanent, complete and irreversible and substantiated by physical examination and investigation to be permanent, complete and irreversible.

42. Policy means these Policy wordings, the Policy Schedule and any applicable endorsements or Benefits attaching to or forming part thereof. The Policy contains details of the extent of cover available to the Insured Person, what is excluded from the cover and the terms & conditions on which the Policy is issued to the Insured Person.

43. Policy Period means the period commencing from the Policy Start Date, Time and ending at the Policy End Date, Time of the Policy and as specifically appearing in the Policy Schedule during which the policy is valid and Insured Person is liable to get a claim subject to waiting periods and policy terms and conditions

44. Portability means, the right accorded to individual health insurance policyholders (including all members under family cover), to transfer the credit gained for pre-existing conditions and time bound exclusions, from one insurer to another insurer.

45. Period of Cover means the period specified in the Policy Certificate during which the Insured Person is covered under the Policy.

46. Policy Schedule means the Policy Schedule attached to and forming part of the Policy. 47. Post-hospitalization Medical Expenses means medical expenses incurred during pre-defined number

of days immediately after the insured person is discharged from the hospital provided that: a) Such Medical Expenses are incurred for the same condition for which the insured person’s

Hospitalization was required, and b) The In-patient Hospitalization claim for such Hospitalization is admissible by the Insurance

Company. 48. Pre-hospitalization Medical Expenses means medical expenses incurred during predefined number

of days preceding the hospitalization of the Insured Person, provided that: a) Such Medical Expenses are incurred for the same condition for which the Insured Person’s

Hospitalization was required, and b) The In-patient Hospitalization claim for such Hospitalization is admissible by the Insurance

Company. 49. Professional Sports means a sport which would remunerate a player in excess of 50% of his or her

annual income as a means of their livelihood. 50. Pre-existing Disease means any condition, ailment, injury or disease: a) That is/are diagnosed by a physician within 48 months prior to the effective date of the policy issued by

the insurer or its reinstatement or

b) For which medical advice or treatment was recommended by, or received from, a physician within 48

months prior to the effective date of the policy or its reinstatement.

51. Proposal and Declaration Form means any initial or subsequent declaration made by the policyholder and is deemed to be attached and which forms a part of this Policy.

a) While filling the proposal form, you are expected to provide all information pertaining to your health and to the cover you would be opting/buying in this policy

Any non-declaration of information which insurance Company should have known for underwriting this policy can lead to cancellation of policy and Company will have a right to forfeit the premium.


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52. Reasonable and Customary Charges means the charges for services or supplies, which are the standard charges for the specific provider and consistent with the prevailing charges in the geographical area for identical or similar services, taking into account the nature of the illness / Injury involved .

53. Renewal means the terms on which the contract of insurance can be renewed on mutual consent with a provision of grace period for treating the renewal continuous for the purpose of gaining credit for pre-existing diseases, time-bound exclusions and for all waiting periods.

54. Service Provider means any person, organization, institution, company providing services in individual capacity or through aggregation that has been empanelled with the Insurance Company to provide services specified under the benefits (including add-ons) to the Insured Person on cashless or reimbursement basis. These shall also include providers empanelled to form a part of network other than hospitals

55. Specific Vector-Borne Disease means Dengue, Chickungunya, Kala azar, Japanese encephalitis and Filariasis.

56. Sum Insured means the amount specified in the Policy Certificate against a Benefit or set of Benefits that represents Our maximum, total and cumulative liability for any and all claims made in respect of that Insured Person during the Period of Cover under that Benefit/set of Benefits.

57. You / Your means person or the entity named as the policyholder in the Policy Schedule and who is responsible for payment of premium.

58. Waiting Period means a time-bound exclusion period related to condition(s) specified in the Policy Certificate which shall be served before a claim related to such condition becomes admissible.

59. We/ Our / Us means the ICICI Lombard General Insurance Company Limited.


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II. SCOPE OF COVER

This Policy is a contract of insurance between the Policyholder and Us which is subject to the receipt of

premium against each Benefit in full (first installment in case the customer has opted for Periodic Premium

Payment option) in respect of the Insured Persons and the terms, conditions and exclusions of this Policy.

The customer may opt for any one or more base benefits under one or more sections. Extensions may be

opted only if a base benefit under the respective section has been opted. The Policy Certificate will specify

which of the following Basic Benefits and Extensions are applicable and in force for the Insured Person.

Claims made in respect of an Insured Person for any Benefit applicable to the Insured Person shall be

subject to the availability of the Sum Insured, applicable sub-limits for the Benefit claimed as specified in the

Policy Certificate and the terms, conditions and exclusions of this Policy.

All claims shall be made in accordance with the procedures set out in this Policy. Admitted claims will be

payable to the Insured Person or the Nominee (as applicable).

SECTION A – ACCIDENTAL INJURY BENEFITS

Our maximum, total and cumulative liability for claims arising in respect of the Insured Person during

the Period of Cover under Benefits A.1.1, A.1.2, and A.1.3 shall be the Sum Insured as specified

against this set of Benefits in the Policy Certificate.

Section A.1 – Death and Disability Related Benefits

A.1.1 Basic Benefit: Death Benefit

We will pay the Sum Insured specified against this Benefit in the Policy Certificate in the manner specified

in the Policy Certificate if an Insured Person suffers an Injury due to an Accident that occurs during the

Period of Cover and that Injury solely and directly results in the Insured Person’s death within 365 days from

the date of the Accident.

On the acceptance of a claim under this Benefit and any other applicable Benefit pertaining to the same

event, all cover under this Policy shall immediately and automatically cease in respect of that Insured Person.

A.1.2 Basic Benefit: Permanent Total Disablement (PTD) Benefit


in the Policy Certificate if an Insured Person suffers an Injury due to an Accident that occurs during the

Period of Cover and that Injury solely and directly results in the Permanent Total Disablement of the Insured

Person within 365 days from the date of the Accident.

This Benefit shall be payable subject to the following:

i. If the Insured Person dies before a claim has been admitted under this Benefit, then no amount will be payable under this Benefit, but a claim will be considered under Benefit A.1.1, if in force for the Insured Person.

ii. If the Insured Person suffers Injuries resulting in more than one of the Permanent Total Disablements, then Our maximum, total and cumulative liability under this Benefit shall be limited to the Sum Insured.


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iii. If We have admitted a claim for Permanent Total Disablement in accordance with this Benefit, then We shall not be liable to make any payment under the Policy under Benefit A.1.1 on the death of the Insured Person, if the Insured Person subsequently dies. However, any other applicable Benefits which may get triggered will be considered in accordance with the terms and conditions of the applicable Benefits.

iv. We will only accept one claim under this Benefit in the lifetime of the Insured Person. On the acceptance of a claim under this Benefit, all cover under this Benefit and Benefit B.2 in respect of the Insured Person shall immediately and automatically cease.

v. On the acceptance of a claim under this Benefit, insurance cover under any other applicable Benefits under this Policy whether in the present Period of Cover or any subsequent Period of Cover shall continue subject to the availability of the Sum Insured and the terms, conditions and exclusions of the Policy.

A.1.3 Basic Benefit: Permanent Partial Disablement (PPD) Benefit

We will pay the percentage of the Sum Insured (specified against this Benefit in the Policy Certificate) in the

manner which is specified in the table below if an Insured Person suffers an Injury due to an Accident that

occurs during the Period of Cover and that Injury solely and directly results in the Permanent Partial

Disablement of the Insured Person (which is of the nature specified in the table below) within 365 days from

the date of the Accident.

For the purpose of this Benefit, Permanent Partial Disablement means total and/or partial irrecoverable loss

of use or the actual loss by physical separation of the body parts as specified in the table below:

SR No.

LOSSES COVERED % OF SUM INSURED payable

1 Loss of one entire hand 70

2 Loss of one entire foot 70

3 Loss of use of one eye 50

4 Loss of all toes 20

5 Loss of great toe - both phalanges 5

6 Loss of great toe - one phalanx 2

7 Other than great toe if more than one toe lost each 5

8 Loss of use of both ears 75

9 Loss of use of one ear 30

10 Loss of four fingers and thumb of one hand 40

11 Loss of four fingers 35

12 Loss of thumb - both phalanges 25

13 Loss of thumb - one phalanx 10

14 Loss of index finger - three phalanges 10

15 Loss of index finger - two phalanges 8

16 Loss of index finger - one phalanx 4

17 Loss of middle finger - three phalanges 6

18 Loss of middle finger - two phalanges 4

19 Loss of middle finger - one phalanx 2


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20 Loss of ring finger - three phalanges 5

21 Loss of ring finger - two phalanges 4

22 Loss of ring finger - one phalanx 2

23 Loss of little finger - three phalanges 4

24 Loss of little finger - two phalanges 3

25 Loss of little finger - one phalanx 2

26 Loss of metacarpus - first or second (additional) 3

27 Loss of metacarpus - third, fourth or fifth (additional) 2


i. If the Insured Person dies before a claim has been admitted under this Benefit, then no amount will be payable under this Benefit, but a claim will be considered under Benefit A.1.1.

ii. If a claim is accepted under this Benefit in respect of an Insured Person and the amount due under this claim and claims already admitted under the Benefit in respect of the Insured Person will cumulatively lead to the Sum Insured being exceeded then Our maximum, total and cumulative liability under any and all such claims will be limited to the Sum Insured.

iii. On the acceptance of a claim under this Benefit, the Insured Person’s insurance cover under this Benefit and the Policy shall continue, subject to the availability of the Sum Insured and the terms, conditions and exclusions of this Policy.

A.1.4 Basic Benefit: Temporary Total Disablement (TTD) Benefit

If an Insured Person suffers an Injury due to an Accident that occurs during the Period of Cover and that

Injury solely and directly results in the incapacitation of the Insured Person which prevents the Insured

Person from engaging in any employment or occupation on a temporary basis, then We will pay the weekly

amount specified against this Benefit in the Policy Certificate for the duration that the Temporary Total

Disablement continues.


i. We shall not be liable to make any payment under this Benefit in respect of the Insured Person for more than the total number of weeks specified in the Policy Certificate for any and all claims arising within the Period of Cover under this Benefit.

ii. If the Injury is sustained to or suffered in relation to the spine and its muscular girdle, ligamentous system, cartilage, nervous system and blood supply to the spine which is not detectable by means of radiological scanning, imaging, or neurological fallout testing, then Our liability under this Benefit shall extend for a maximum period of five (5) weeks.

iii. In the event of any dispute as to the date when the Temporary Total Disablement ceased, such date shall be finally determined by an external Medical Practitioner approved by Us who certifies either:

a) the date upon which the Insured Person recovered; or b) the date upon which the Insured Person recovered as far as he/she will ever recover.

iv. If the Insured Person is disabled for a part of a week, then only a proportionate part of the weekly amount will be payable in respect of that week.

A.1.5 Basic Benefit: Common Carrier Accident Benefit


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in the Policy Certificate if an Insured Person suffers an Injury due to an Accident to the Common Carrier on

which the Insured Person is travelling during the Period of Cover and that Injury solely and directly results in

the Insured Person’s death or Permanent Total Disablement. We will only accept one claim under this Benefit

in the lifetime of the Insured Person.

On the acceptance of a death claim under this Benefit, all cover under this Policy in respect of the Insured

Person shall immediately and automatically cease.

On the acceptance of a Permanent Total Disablement claim under this Benefit, all cover under this Benefit

and Benefit B.2 in respect of the Insured Person shall immediately and automatically cease.

However, insurance cover under any other applicable Benefits under this Policy whether in the present

Period of Cover or any subsequent Period of Cover shall continue subject to the availability of the Sum

Insured and the terms, conditions and exclusions of the Policy.

A.1.6 Basic Benefit: Adventure Sports Benefit


in the Policy Certificate if an Insured Person suffers an Injury due to an Accident while engaging in Adventure

Sports during the Period of Cover and that Injury solely and directly results in the Insured’s Person’s death

or Permanent Total Disablement within 365 days from the date of the Accident.


i. The Insured Person was engaging in the Adventure Sport under the supervision of a trained professional.

ii. If the Insured Person received or was eligible to receive any kind of remuneration for performing the Adventure Sport, no amount shall be payable under this Benefit. However, we would cover running marathon events provided that the distance of such event does not exceed 42 kilometres

iii. Section A Exclusion (9) shall not apply to the extent of the cover under this Benefit. iv. We will only accept one claim under this Benefit in the lifetime of the Insured Person. On the

acceptance of a claim under this Benefit, all cover under this Benefit in respect of the Insured Person shall immediately and automatically cease but insurance cover under any other applicable Benefits under this Policy whether in the present Period of Cover or any subsequent Period of Cover shall continue subject to the availability of the Sum Insured and the terms, conditions and exclusions of the Policy.

A.1.7 Basic Benefit: Children's Education Grant Benefit

If the Insured Person suffers an Injury due to an Accident that occurs during the Period of Cover and solely

and directly results in the Insured Person’s death or Permanent Total Disablement, We will pay the Sum

Insured specified against this Benefit in the Policy Certificate in the manner specified in the Policy Certificate

in respect of the surviving Dependent Children of the Insured Person, irrespective of whether the child is an

Insured Person under this Policy. We will only accept one claim under this Benefit during the Period of Cover

in respect of the Insured Person. On the acceptance of a claim under this Benefit, all cover under this Benefit

in respect of the Insured Person shall immediately and automatically cease but insurance cover under any


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other applicable Benefits under this Policy during the Period of Cover shall continue subject to the availability

of the Sum Insured and the terms, conditions and exclusions of the Policy.

If the Insured Person’s Dependent Children also die in the same Accident or due to any event occurring after

the death of the Insured Person and before the claim amount payable under this Benefit can be paid in full,

the amount payable shall be paid to the Dependent Child’s legal heirs in the manner specified in the Policy

Certificate.

For the purpose of this Benefit, Dependent Child means a child of the Insured Person who is less than 25

years of Age on the date of Accident and is financially dependent on the Insured Person.


i. Our maximum, total and cumulative liability under this Benefit is the Sum Insured specified against this Benefit, irrespective of the number of surviving Dependent Children of the Insured Person.

A.1.8 Basic Benefit: EMI Benefit

If an Insured Person suffers an Injury due to an Accident that occurs during the Period of Cover and solely

and directly results in the Temporary Total Disablement (as defined in Benefit A.1.4) or the Permanent Partial

Disablement (which is only of the nature specified in the table below) of the Insured Person, then We will

pay the EMI Amount for the number of EMIs specified in the Policy Certificate, from the first EMI Amount

falling due after the onset of the Injury in accordance with the loan re-payment schedule issued by the

financier on disbursement of the Loan.



Permanent Partial Disablement: LOSSES COVERED

One entire hand

One entire foot

Loss of Use of one eye

Loss of Use of both ears

Loss of four fingers and thumb of one hand


i. We shall not be liable make any payment under this Benefit after the earlier of the Insured Person regaining employment/occupation or the maximum number of EMI Amounts specified in the Policy Certificate being completed.

ii. If a claim is made under this Benefit in respect of the Temporary Total Disablement of the Insured Person, then We will consider the claim under this Benefit only if the Insured Persons continues


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to remain in a state of Temporary Total Disablement for a minimum period of 30 consecutive days iii. The Insured Person must be a salaried employee in order to avail this Benefit on the on-set of

Temporary Total Disablement. For the Insured Person to avail this Benefit on the on-set of Permanent Partial Disablement, the Insured Person may be either a salaried employee or self-employed.

iv. Any payments that are overdue and unpaid by the Insured Person prior to the occurrence of the Accident will not be considered for the purpose of this Benefit and shall be deemed as paid by the Insured Person.

v. We will only accept one claim under this Benefit during the Period of Cover in respect of the Insured Person. On the acceptance of a claim under this Benefit, all cover under this Benefit in respect of the Insured Person shall immediately and automatically cease but insurance cover under any other applicable Benefits under this Policy during the Period of Cover shall continue subject to the availability of the Sum Insured and the terms, conditions and exclusions of the Policy.

A.1.9 Basic Benefit: Loan Protection Benefit

If an Insured Person suffers an Injury due to an Accident that occurs during the Period of Cover and solely

and directly results in the death or the Permanent Total Disablement of the Insured Person, then We will pay

an amount equal to the principal outstanding amount as on the date of Accident in respect of the Insured

Person’s outstanding Loan specified in the Policy Certificate.


i. We will make payment under this Benefit in accordance with the amortization schedule (as on Loan disbursement or the actual amount outstanding on the date of the Accident, which ever is less).

ii. If the Sum Insured under this Benefit is less than the Insured Person’s outstanding Loan amount on the date of the Accident, then Our liability under this Benefit shall be reduced proportionately and shall in any event not exceed the Sum Insured.

iii. Any payments that are overdue and unpaid by the Insured Person prior to the occurrence of the Accident will not be considered for the purpose of this Benefit and shall be deemed as paid by the Insured Person.

iv. We will only accept one claim under this Benefit during the Period of Cover in respect of the Insured Person. On the acceptance of a claim under this Benefit, all cover under this Benefit in respect of the Insured Person shall immediately and automatically cease but insurance cover under any other applicable Benefits under this Policy during the Period of Cover shall continue subject to the availability of the Sum Insured and the terms, conditions and exclusions of the Policy.

A.1.10 Extension: Mobility Benefit

We will pay a lump sum amount which is equal to the claim amount that would be payable under Benefit

A.1.2 or A.1.3 (if a claim is accepted under that Benefit) to the Insured Person towards modification of home,

office and / or vehicle or towards purchase of an Artificial Limb or any prosthesis or any other expenses

because of Permanent Total Disablement or Permanent Partial Disablement (which is only of the nature

specified in the table below) covering the disabilities mentioned in the table below suffered by the Insured

Person. However, Our liability for payment of all claims under this Benefit in aggregate for Period of Cover

shall in no case exceed the Sum Insured for this Benefit as specified in the Policy Certificate.


13



Permanent Partial Disablement: LOSSES

COVERED

One entire hand

One entire foot

Loss of Use of one eye

Loss of Use of both ears

Loss of four fingers and thumb of one hand


i. We have accepted a claim under Benefit A.1.2 or A.1.3 in respect of that Insured Person. ii. We will only accept only one claim under this Benefit in the lifetimeof the Insured Person. On the

acceptance of a claim under this Benefit, all cover under this Benefit in respect of the Insured Person shall immediately and automatically cease but insurance cover under any other applicable Benefits under this Policy during the Period of Cover shall continue subject to the availability of the Sum Insured and the terms, conditions and exclusions of the Policy.

A.1.11 Basic Benefit: Orphan Benefit


and directly results in the Insured Person’s death, We will pay the Sum Insured in the manner specified in

the Policy Certificate in respect of the surviving Dependent Children of the Insured Person, irrespective of

whether the child is an Insured Person under this Policy.

For the purpose of this Benefit, Dependent Child means a child of the Insured Person who is less than Age

25 on the date of the Accident and does not have any independent source of income.


i. The Dependent Child’s other parent also dies as a result of the same Accident or has pre-deceased the Insured Person.

ii. Our maximum, total and cumulative liability under this Benefit is the Sum Insured, irrespective of the number of surviving Dependent Children of the Insured Person.

iii. If the claim payment under this Benefit is being made as per Periodic Claim Payment Clause as specified in the Policy Certificate and the Dependent Child dies before the entire payment has been under this Benefit, then the remaining instalments shall be paid in one lump sum to the Dependent Child’s legal heirs.

iv. We will only accept one claim under this Benefit in the lifetime of the Insured Person. On the


14

acceptance of a claim under this Benefit, all cover under this Benefit in respect of the Insured Person shall immediately and automatically cease.

A.1.12 Extension: Repatriation of Mortal Remains Benefit


and directly results in the Insured Person’s death, We will pay the Sum Insured specified against this Benefit

in the Policy Certificate for transporting the mortal remains (including ash) of the Insured Person from the

place of death to the residence of the Insured Person.


i. We have accepted a claim under Benefit A.1.1 in respect of that Insured Person. ii. The death of the Insured Person occurred in a location that is not the city/place of residence of

the Insured Person.

A.1.13 Extension: Counseling Benefit



Insured specified against this Benefit in the Policy Certificate in respect of the expenses incurred on

professional counselling in respect of the Insured Person or the Nominee/legal heir (as the case may be)

provided that We have accepted a claim under Benefit A.1.1 or A.1.2.

We will only accept one claim under this Benefit during the Period of Cover in respect of the Insured Person.

On the acceptance of a claim under this Benefit, all cover under this Benefit in respect of the Insured Person

shall immediately and automatically cease but insurance cover under any other applicable Benefits under

this Policy during the Period of Cover shall continue subject to the availability of the Sum Insured and the

terms, conditions and exclusions of the Policy.

A.1.14 Basic Benefit: Parental Care Benefit



Insured specified against this Benefit in the Policy Certificate in the manner specified in the Policy Certificate

in respect of the surviving parents of the Insured Person, irrespective of whether the parent(s) is an Insured

Person under this Policy.


i. Our maximum, total and cumulative liability under this Benefit is the Sum Insured, irrespective of

whether one or both parents of the Insured Person are alive. ii. If the claim payment under this Benefit is being made as per Periodical Claim Payment Clause

as specified in the Policy Certificate and the surviving parents die before the entire payment has

been under this Benefit, then the remaining instalments shall be paid in one lump sum to the

parent’s legal heirs.


15

iii. We will only accept one claim under this Benefit in the lifetime of the Insured Person. On the acceptance of a claim under this Benefit, all cover under this Benefit in respect of the Insured Person shall immediately and automatically cease but insurance cover under any other applicable Benefits under this Policy during the Period of Cover shall continue subject to the availability of the Sum Insured and the terms, conditions and exclusions of the Policy.

A.1.15 Extension: Repatriation in case of Permanent Disability Benefit


and directly results in the Permanent Total Disablement of the Insured Person, We will pay the Sum Insured

specified against this Benefit in the Policy Certificate in respect of transporting the Insured Person from the

place of Accident or Hospitalization to the residence of the Insured Person.


i. We have accepted a claim under Benefit A.1.2 in respect of that Insured Person. ii. The Accident occurred in a location that is not the city/place of residence of the Insured Person. iii. We will only accept one claim under this Benefit during the Period of Cover in respect of the

Insured Person. On the acceptance of a claim under this Benefit, all cover under this Benefit in respect of the Insured Person shall immediately and automatically cease but insurance cover under any other applicable Benefits under this Policy during the Period of Cover shall continue subject to the availability of the Sum Insured and the terms, conditions and exclusions of the Policy.

SECTION A.2 – Hospitalization Expenses Related Benefits

A.2.1 Basic Benefit: Accidental Hospitalization Expenses Reimbursement Benefit

We will reimburse the Medical Expenses incurred in respect of the Insured Person for treatment of Injury

sustained by the Insured Person in an Accident which occurs within the Period of Cover and solely and

directly requires the Insured Person to be Hospitalized.


i. The Hospitalization is for Medically Necessary Treatment and is commenced and continued on the written advice of the treating Medical Practitioner.

ii. The Insured Person is admitted to the Hospital within 7 days of the occurrence of the Accident. i. We will reimburse only those Medical Expenses that are Reasonable and Customary Charges. ii. We shall not be liable to make any payment in respect of any non-payable items, the list of which

is attached to this Policy and is available on Our website www.icicilombard.com iii. We shall not be liable to pay any expenses incurred towards treatment in any hospital or by any

Medical Practitioner or any other provider specifically excluded by the Insurer and disclosed in its website / notified to the policyholders are not admissible. However, in case of life threatening situations or following an accident, expenses up to the stage of stabilization are payable but not the complete claim.

iv. Our liability to make any payment under this Benefit shall be in excess of the per event Deductible or per event Franchise stated in the Policy Certificate, if applicable

v. If a claim is accepted under this Benefit in respect of an Insured Person and the amount due under this claim and claims already admitted under the Benefit in respect of the Insured Person


16

will cumulatively lead to the Sum Insured being exceeded then Our maximum, total and cumulative liability under any and all such claims will be limited to the Sum Insured.

vi. If We have admitted a claim under this Benefit, then on the Insured Person/Nominee’s advance written request, We may pay the amount due under this Benefit directly to the Hospital where the Insured Person was treated provided that We are able to offer Cashless Facility at that Hospital.

A.2.2 Extension: Accidental Pre & Post Hospitalization Expenses Benefit

We will reimburse the Pre-hospitalization Medical Expenses incurred for up-to 7 days immediately preceding

the Hospitalization of the Insured Person and the Post-hospitalization Medical Expenses incurred for up-to

60 days immediately following the Insured Person’s discharge from Hospital.


i. We have accepted a claim under Benefit A.2.1 in respect of the Insured Person. ii. We will reimburse only those Pre-hospitalization Medical Expenses and Post-hospitalization

Medical Expenses that are Reasonable and Customary Charges. iii. If a claim is accepted under this Benefit in respect of an Insured Person and the amount due

under this claim and claims already admitted under the Benefit in respect of the Insured Person will cumulatively lead to the Sum Insured being exceeded then Our maximum, total and cumulative liability under any and all such claims will be limited to the Sum Insured.

A.2.3 Basic Benefit: Accidental Hospitalization Daily Cash Benefit


Injury solely and directly requires the Insured Person to be Hospitalized, then We will pay the daily amount

specified in the Policy Certificate for each continuous and completed day of Hospitalization.



ii. The Insured Person is admitted to the Hospital within 7 days of the occurrence of the Accident.

iii. Our liability to make any payment under this Benefit shall be in excess of the per event Deductible or per event Franchise stated in the Policy Certificate, if applicable.

iv. If a claim is accepted under this Benefit in respect of an Insured Person and the amount due under this claim and claims already admitted under the Benefit in respect of the Insured Person will cumulatively lead to the Sum Insured being exceeded then Our maximum, total and cumulative liability under any and all such claims will be limited to the Sum Insured and the maximum number of days as mentioned against this Benefit in the Policy Certificate.

v. If We have admitted a claim under this Benefit, then on the Insured Person/Nominee’s advance written request, We may pay the amount due under this Benefit directly to the Hospital where the Insured Person was treated provided that We are able to offer Cashless Facility at that Hospital.

A.2.4 Extension: Air Ambulance Benefit


17


Injury solely and directly requires the Insured Person to be Hospitalized, We will pay the Sum Insured

specified against this Benefit in the Policy Certificate in respect of Air Ambulance services for transportation

of the Insured Person from the site of the Accident to the nearest Hospital or from the site of first treatment

to a higher center of care where the Insured Person is being treated to the nearest Hospital.


i. The transportation is required to stabilise the condition of the Insured Person and the Insured Person is alive while boarding the Air Ambulance.

ii. The Air Ambulance services are availed within 7 days from the date of the Accident.

We will only accept one claim under this Benefit during the Period of Cover in respect of the Insured Person.

On the acceptance of a claim under this Benefit, all cover under this Benefit in respect of the Insured Person

shall immediately and automatically cease but insurance cover under any other applicable Benefits under

this Policy during the Period of Cover shall continue subject to the availability of the Sum Insured and the

terms, conditions and exclusions of the Policy.

A.2.5 Extension: Comatose Benefit

We will pay the Sum Insured specified against this Benefit in the Policy Certificate if an Insured Person

suffers an Injury due to an Accident that occurs during the Period of Cover and that Injury solely and directly

results in the Insured Person being in a Coma within 30 days from the date of the Accident.


i. We will only accept one claim under this Benefit during in the lifetime of the Insured Person. On the acceptance of a claim under this Benefit, all cover under this Benefit in respect of the Insured Person shall immediately and automatically cease but insurance cover under any other applicable Benefits under this Policy during the Period of Cover shall continue subject to the availability of the Sum Insured and the terms, conditions and exclusions of the Policy.

A.2.6 Extension: Broken Bones Benefit

We will pay the percentage of the Sum Insured (specified against this Benefit in the Policy Certificate) in the

manner which is specified in the table below if an Insured Person suffers an Injury due to an Accident that

occurs during the Period of Cover and that Injury solely, directly and immediately results in a fracture (of the

nature specified in the table below).

Sr No.

Region Fracture % of the Sum Insured payable

1 Skull

Compound fractures of skull with damage to the brain tissue

100%

All other fractures 75%


18

2 Lower jaw

Multiple fractures (at least one compound fracture)

75%

Compound fracture 50%


3

Shoulder blade, kneecap, sternum, hand (excluding fingers and wrist), foot (excluding toes and heel)


75%



4

Upper arm (including elbow and wrist)


75%

Colles type fracture (compound) 50%


5 Spinal cord

All compression fractures 30%

All spinous, transverse process or pedicle fractures

25%

All other vertebral fractures 20%

6

Rib or ribs, cheekbone, coccyx, upper jaw, nose, toe and toes, finger or fingers

Multiple fractures (at least one compound) 50%



7 Thigh or heel:




8

Hip or pelvis (excluding thigh or coccyx):




9 Lower leg, clavicle, ankle,





i. If a claim is accepted under this Benefit in respect of an Insured Person and the amount due under this claim and claims already admitted under the Benefit in respect of the Insured Person will cumulatively lead to the Sum Insured being exceeded then Our maximum, total and cumulative liability under any and all such claims will be limited to the Sum Insured.

ii. On the acceptance of a claim under this Benefit, the Insured Person’s insurance cover under this


19

Benefit and the Policy shall continue, subject to the availability of the Sum Insured and the terms, conditions and exclusions of this Policy.

iii. We will be liable to pay a claim under this Benefit only if the Insured Person is taken to a medical care facility where he/she is diagnosed for the above mentioned fractures by a Medical Practitioner.

A.2.7 Extension: Compassionate Visit Benefit

We will pay the Sum Insured specified against this Benefit in the Policy Certificate in respect of the expenses

incurred on tickets on a Common Carrier for an Immediate Family Member of the Insured Person to travel

to the place of death or Hospitalization of the Insured Person


i. We have accepted a claim under Benefit A.1.1, Benefit A.1.2 or Benefit A.2.6 (where the percentage of the Sum Insured payable is at least 50%) in respect of the Insured Person.

ii. The Insured Person is Hospitalized at a distance of at least 100 kilometres from his place of residence.

iii. The Medical Practitioner treating the Insured person recommends in writing the personal attendance of an Immediate Family Member.

iv. We will only accept one claim under this Benefit during the Period of Cover in respect of the Insured Person. On the acceptance of a claim under this Benefit, all cover under this Benefit in respect of the Insured Person shall immediately and automatically cease but insurance cover under any other applicable Benefits under this Policy during the Period of Cover shall continue subject to the availability of the Sum Insured and the terms, conditions and exclusions of the Policy.

A.2.8 Extension: Burns Benefit

We will pay the percentage of the Sum Insured (specified against this Benefit in the Policy Certificate) which

is specified in the table below if an Insured Person suffers an Injury due to an Accident that occurs during

the Period of Cover and that Injury solely and directly results in a Second Degree Burns or Third Degree

Burns (of the nature specified in the table below).

Losses Covered

% of the Sum Insured payable

1)Head, Face and Neck

a) Third degree burns 100%

b) Second degree burns of 10% or more of the total head surface area 75%

c) Second degree burns of 3% or more, but less than 10% of the total head surface area

25%

2) Rest of Body

a) Third degree burns of 25% or more of the total body surface area 100%

b) Second degree burns of 25% or more of the total body surface area 75%

c) Second degree burns of 10% or more, but less than 25% of the total body surface area

50%


20

d) Second degree burns of 5% or more, but less than 10% of the total body surface area

25%

For the purpose of this Benefit: Burn means an injury caused by exposure to heat or flame including

chemical and electric burns. Second Degree Burns - Involves the epidermis and part of the dermis layer

of skin and are also known as partial burns

Third-degree burns - with scarring that cover at least 20% of the body’s surface area. The diagnosis must confirm the total area involved using standardized, clinically accepted, body surface area charts covering 20% of the body surface area.

First degree burns are not covered under this Policy.


i. If a claim is accepted under this Benefit in respect of an Insured Person and the amount due under this claim and claims already admitted under the Benefit in respect of the Insured Person will cumulatively lead to the Sum Insured being exceeded then Our maximum, total and cumulative liability under any and all such claims will be limited to the Sum Insured.

ii. On the acceptance of a claim under this Benefit, the Insured Person’s insurance cover under this Benefit and the Policy shall continue, subject to the availability of the Sum Insured and the terms, conditions and exclusions of this Policy.

A.2.9 Extension: Ambulance Charges Benefit


Injury solely and directly requires the Insured Person to be Hospitalized, We will pay the Sum Insured

specified against this Benefit in the Policy Certificate in respect of road Ambulance Services for

transportation of the Insured Person from the site of the Accident to the nearest Hospital or from the site of

first treatment to a higher center of care.


i. The transportation is recommended in writing by a Medical Practitioner.

ii. We will only accept one claim under this Benefit during the Period of Cover in respect of the Insured Person. On the acceptance of a claim under this Benefit, all cover under this Benefit in respect of the Insured Person shall immediately and automatically cease but insurance cover under any other applicable Benefits under this Policy during the Period of Cover shall continue subject to the availability of the Sum Insured and the terms, conditions and exclusions of the Policy.

SECTION A.3 – Other Benefits


21

A.3.1 Extension: Assault Benefit

We will pay the Sum Insured specified against this Benefit in the Policy Certificate if the Insured Person

suffers an Injury due to an Accident which is a violent crime or Assault that occurs during the Period of Cover

and that Injury solely and directly requires the Insured Person to be Hospitalized.

We will only accept one claim under this Benefit during the Period of Cover in respect of the Insured Person. On the acceptance of a claim under this Benefit, all cover under this Benefit in respect of the Insured Person shall immediately and automatically cease but insurance cover under any other applicable Benefits under this Policy during the Period of Cover shall continue subject to the availability of the Sum Insured and the terms, conditions and exclusions of the Policy.

A.3.2 Extension: Mysterious Disappearance Benefit


in the Policy Certificate if the Insured Person has disappeared for more than 365 days from the date of the

Accident of the Common Carrier on which the Insured Person was travelling during the Period of Cover.


i. The Insured Person’s disappearance is certified in writing by the police authorities. ii. We shall not be liable to make any payment under this Benefit if the Common Carrier on which

the Insured Person was travelling was a private taxi, yacht, charter airline or a rented car. iii. On the acceptance of a claim under this Benefit, all cover under this Policy shall immediately and

automatically cease in respect of that Insured Person. iv. If after payment of claim under this Benefit, the Insured Person is found to be alive, We reserve

the right to recover in full from the Nominee/legal heir of the Insured Person the amount paid under this Benefit as well as stop any future payments due in respect of this Benefit.

EXCLUSIONS AND LIMITATIONS APPLICABLE TO SECTION A

We shall not be liable to make any payment for any claim under Section A of this Policy in respect of an

Insured Person, directly or indirectly for, caused by, arising from or in any way attributable to any of the

following:

1. War, invasion, act of foreign enemy hostilities or warlike operations (whether war be declared or

not) or civil commotion or rebellion, revolution, insurrection, mutiny, arrests, detainments of all

kinds and political gatherings, engaging in aviation other than as a passenger (fare paying or

otherwise) in any licensed standard type of aircraft.

2. Any Injury sustained while performing duty in army, navy, air force, paramilitary force, police or

any other such institution.

3. Any event which occurs whilst the Insured Person is operating or learning to operate any aircraft

or common carrier, or performing duties as a member of the crew on any aircraft, or scheduled

airlines or is engaging in aviation, or whilst the Insured Person is mounting into, or dismounting

from or traveling in any balloon or aircraft other than as a passenger (fare-paying or otherwise)

in any scheduled airline anywhere in the world.


22

4. Breach of law or while being involved in any unlawful activity.

5. Any Injury / Illness arising from intentional self- Injury, suicide or attempted suicide.

6. Any Injury / Illness arising whilst under the influence of alcohol or intoxicating drugs or substance

abuse of any kind.

7. Any Injury / Illness occurring whilst working in underground mines or explosives magazines, or

involving electrical installation with high tension supply, or as jockeys or circus personnel

8. Any Accidental Injury / Illness directly or indirectly caused by venereal disease

9. Injury sustained whilst engaging in Adventure Sports (Unless specifically covered and

mentioned in the policy certificate).

10. Any Injury that has occurred prior to the commencement of Policy of Cover whether or not the

same has been treated, or medical advice, diagnosis, care or treatment has been sought.

11. Expenses incurred on eyeglasses, contact lenses, hearing aids and examination for the

prescription or fitting thereof.

12. Any Illness, complication or ailment not arising out of or connected to Injury.

13. Payment of compensation in respect of death, disablement (whether of a permanent nature or of

a temporary nature), Injury, or illness of the Insured Person resulting directly from, or indirectly

caused by, or contributed to or aggravated or prolonged by, childbirth or pregnancy or in

consequence thereof.

14. Death, disablement (whether of a permanent nature or of a temporary nature), Injury, or Illness

arising from or caused by ionizing radiation or contamination by radioactivity from any nuclear

fuel (explosive or hazardous form) or resulting from or from any other cause or event contributing

concurrently or in any other sequence to the loss, claim or expense from any nuclear waste from

the combustion of nuclear fuel, nuclear, chemical or biological attack.

15. Circumcision or strictures, vaccination, inoculation, sex change, beauty treatment of any

description, intentional self Injury, insanity, dissipation, nervous breakdown (which expression

shall cover also general debility, "run down" conditions and "general overhaul"), venereal

disease, intemperance, use of intoxicating drugs, or any Illness, Injury, death or disablement

directly or indirectly due to any one or more of them.

16. Dental treatment, eye treatment and plastic surgery unless medically necessitated as a

consequence of an Injury sustained in an Accident during the Period of Cover.

17. Any Hospitalization not arising out of an Injury sustained in an Accident during the Period of

Cover.

18. Routine medical, dental, eye and ear examinations.


23

19. All cosmetic/aesthetic surgeries including but not limited to lasik surgery.

EXCLUSIONS AND LIMITATIONS APPLICABLE TO SECTION A.2

We shall not be liable to make any payment for any claim under Section A.2 of this Policy in respect of an


following:



kinds and political gatherings, engaging in aviation other than as a passenger (fare paying or

otherwise) in any licensed standard type of aircraft.

2. Any Injury sustained while performing duty in army, navy, air force, paramilitary force, police or

any other such institution.




from or traveling in any balloon or aircraft other than as a passenger (fare-paying or otherwise)

in any scheduled airline anywhere in the world.

4. Breach of Law (Code – Excl 10) - Expenses for treatment directly arising from or consequent

upon any Insured Person committing or attempting to commit a breach of law with criminal intent

5. Any Injury / Illness arising from intentional self- Injury, suicide or attempted suicide.

6. Any Injury / Illness arising whilst under the influence of alcohol or intoxicating drugs or substance

abuse of any kind.

7. Any Accidental Injury / Illness directly or indirectly caused by venereal disease

8. Hazardous or Adventure Sport (Code – Excl 09) - Expenses related to any treatment

necessitated due to participation as a professional in hazardous or adventure sports, including

but not limited to, para-jumping, rock climbing, mountaineering, rafting, motor racing, horse

racing or scuba diving, hand gliding, sky diving, deep-sea diving. (Unless specifically covered

and mentioned in the policy certificate)



10. Expenses incurred on eyeglasses, contact lenses, hearing aids and examination for the

prescription or fitting thereof.

11. Any Illness, complication or ailment not arising out of or connected to Injury.

12. Payment of compensation in respect of death, disablement (whether of a permanent nature or of

a temporary nature), Injury, or illness of the Insured Person resulting directly from, or indirectly

caused by, or contributed to or aggravated or prolonged by, childbirth or pregnancy or in

consequence thereof.


24

13. Death, disablement (whether of a permanent nature or of a temporary nature), Injury, or Illness

arising from or caused by ionizing radiation or contamination by radioactivity from any nuclear

fuel (explosive or hazardous form) or resulting from or from any other cause or event contributing

concurrently or in any other sequence to the loss, claim or expense from any nuclear waste from

the combustion of nuclear fuel, nuclear, chemical or biological attack.

14. Circumcision or strictures, vaccination, inoculation, , intentional self Injury, dissipation,nervous

breakdown (which expression shall cover also general debility, "run down" conditions and

"general overhaul"), venereal disease, intemperance, or any Illness, Injury, death or disablement

directly or indirectly due to any one or more of them.

15. Dental treatment, eye treatment and unless medically necessitated as a consequence of an Injury

sustained in an Accident during the Period of Cover.

16. Any Hospitalization not arising out of an Injury sustained in an Accident during the Period of

Cover.

17. Routine medical, dental, eye and ear examinations.

18. Cosmetic or plastic surgery (Code – Excl 08) - Expenses for cosmetic or plastic surgery or

any treatment to change appearance unless for reconstruction following an Accident,

Burn(s) or Cancer or as part of medically necessary treatment to remove a direct and

immediate health risk to the insured. For this to be considered a medical necessity, it must

be certified by the attending Medical Practitioner.

19. Refractive Error (Code – Excl 15) - Expenses related to the treatment for correction of eye

sight due to refractive error less than 7.5 dioptres

20. Investigation & Evaluation (Code – Excl 04) -

a. Expenses related to any admission primarily for diagnostics and evaluation purposes only are

excluded;

b. Any diagnostic expenses which are not related or not incidental to the current diagnosis and

treatment are excluded.

21. Rest Cure, rehabilitation and respite care (Code – Excl 05) - Expenses related to any

admission primarily for enforced bed rest and not for receiving treatment. This also includes:

I. Custodial care either at home or in a nursing facility for personal care such as help with

activities of daily living such as bathing, dressing, moving around either by skilled nurses or

assistant or non-skilled persons.

II. Any services for people who are terminally ill to address physical, social, emotional and

spiritual needs.

22. Change of Gender Treatments (Code – Excl 07) - Expenses related to any treatment, including

surgical management, to change characteristics of the body to those of the opposite sex

23. Treatment for, Alcoholism, drug or substance abuse or any addictive condition and

consequences thereof. (Code – Excl 12)


25

24. Treatments received in heath hydros, nature cure clinics, spas or similar establishments or private

beds registered as a nursing home attached to such establishments or where admission is

arranged wholly or partly for domestic reasons. (Code – Excl 13)

25. Dietary supplements and substances that can be purchased without prescription, including but not

limited to Vitamins, minerals and organic substances unless prescribed by a medical practitioner as

part of hospitalization claim or day care procedure (Code – Excl 14)

26. Unproven Treatments (Code – Excl 16) - Expenses related to any unproven treatment, services

and supplies for or in connection with any treatment. Unproven treatments are treatments,

procedures or supplies that lack significant medical documentation to support their effectiveness.

27. Excluded providers (Code – Excl 11) - Expenses incurred towards treatment in any hospital or by

any Medical Practitioner or any other provider specifically excluded by the Insurer and disclosed in

its website/notified to the policyholders are not admissible. However, in case of life threatening

situations or following an accident, expenses up to the stage of stabilization are payable but not the

complete claim.

CLAIMS DOCUMENTS FOR SECTION A

On the occurrence of an Insured Event or discovery of any Injury which may give rise to a claim under

Section A of the Policy, We shall be provided with the following necessary and mandatory information and

documentation specified in relation to the Benefit being claimed within 30 days of the occurrence of the

Insured Event:

Documents Required for Section A.1


26

S

. N

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Be

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fit

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A.1.1 Death

Benefit

A.1.2 Permanent

Total

Disableme

nt (PPD)

Benefit

A.1.3 Permanent

Partial

Disableme

nt (PPD)

Benefit

A.1.4 Temporary

Total

Disableme

nt (TTD)

Benefit

A.1.5 Common

Carrier

Accident

Benefit

Documentation requirement mentioned against Benefit A.1.1 or Benefit A.1.2 (As per the nature of injury) & Proof of Travel (Ticket or boarding pass)

A.1.6 Adventure

Sports

Benefit

Documentation requirement mentioned against Benefit A.1.1 or Benefit A.1.2 (As per the nature of injury) & proof of participation in adventure sports such as tickets.

A.1.7

Children's

Education

Grant

Benefit

Documentation requirement mentioned against Benefit A.1.1 or Benefit A.1.2 (As per the nature of injury) & Bonafide Certificate from the educational institute certifying the enrolment of the insured's child in his/her educational course Proof of relationship of children with insured such as passport,/Aadhar card with full DOB /election card / PAN card Age proof of children such as passport,/Aadhar card with full DOB /election card / PAN card


27

A.1.8 EMI Benefit

Documentation requirement mentioned against Benefit A.1.3 or Benefit A.1.4 (As per the nature of injury) & Loan Sanction Letter & Loan Disbursement Letter (including the repayment schedule) & Statement of Account as on date of loss

A.1.9 Loan

protection

Benefit

Documentation requirement mentioned against Benefit A.1.1 or Benefit A.1.2 (As per the nature of injury) & Loan Sanction Letter & Loan Disbursement Letter , Original amortization schedule on disbursal letter, statement of account as on date of loss

A.1.1

0

Mobility

Benefit Documentation requirement mentioned against Benefit A.1.2 .

A.1.1

1

Orphan

Benefit

As per documentation requirement mentioned against Benefit A.1.1 + Death Certificate of the Insured’s spouse Proof of relationship of children with insured such as passport,/Aadhar card with full DOB /election card / PAN card Age proof of children such as passport,/Aadhar card with full DOB /election card / PAN card

A.1.1

2

Repatriatio

n of Mortal

Remains

Benefit

Documentation requirement mentioned against Benefit A.1.1 & All original bills associated with the repatriation expenses

A.1.1

3

Counsellin

g Benefit

Documentation requirement mentioned against Benefit A.1.1 or Benefit A.1.2 (As per the nature of injury)& Proof of counselling sessions along with councillors prescription or certificate

A.1.1

4

Parental

care

Benefit

Documentation requirement mentioned against Benefit A.1.1 or Benefit A.1.2 (As per the nature of injury)& proof of relation such as passport, birth certificate school/college leaving certificate of insured

A.1.1

5

Repatriatio

n in case

of

Permanent

Disability

Benefit

Documentation requirement mentioned against Benefit A.1.2 & All original bills associated with the repatriation expenses

CLAIMS DOCUMENTS FOR SECTION A.2

S.N

o.

Be

ne

fit

Na

me

Cla

im F

orm

Ind

oo

r

Ca

se

Pa

pe

rs

ML

C/

FIR

All

Dia

gn

os

tic

Rep

ort

s

Co

mp

lete

ho

sp

ita

l b

ills

Dis

ch

arg

e S

um

ma

ry

All

re

ce

ipts

& b

ills

rela

ted

to

pre

an

d p

ost

ho

sp

itali

zati

on

All

re

ce

ipts

re

late

d t

o

ava

ilm

en

t o

f a

ny

Am

bu

lan

ce

serv

ices

Ce

rtif

icate

fro

m M

ed

ical

Pra

cti

tio

ner

All

re

ce

ipts

re

late

d t

o

ava

ilm

en

t o

f a

ny

Tra

ve

l

Se

rvic

e t

hro

ug

h a

lic

en

se

d c

om

mo

n c

arr

ier


28

A.2.1 Accidental

Hospitaliza

tion

Expenses

Benefit

A.2.2 Accidental

Pre & Post

Hospitaliza

tion

Expenses

Benefit

A.2.3 Accidental

Hospitaliza

tion Daily

Cash

Benefit

A.2.4 Air

Ambulance

Benefit

A.2.5 Comatose

Benefit

A.2.6 Broken

Bones

Benefit

A.2.7 Compassio

nate Visit

Benefit

A.2.8 Burns

Benefit

A.2.9

Ambulance Charges Benefit

CLAIMS DOCUMENTS FOR SECTION A.3


29

S.NO. Benefit Name

Claim Form MLC or FIR Spot or Inquest

Panchnama

Police Final

Charge sheet

Hospital discharge summary

Indoor case

papers

A.3.1 Assault

Benefit

A.3.2

Mysteriou

s

Disappear

ance

Benefit

Along with the corresponding proof of travel

Police certificate confirming disappeara

nce


30

SECTION B – ANIMAL, INSECT & REPTILE ATTACK BENEFIT

Our maximum, total and cumulative liability for claims arising in respect of the Insured Person during

the Period of Cover under Benefits B.1 and B.2 shall be limited the Sum Insured as specified against

this set of Benefits in the Policy Certificate.

B.1 Basic Benefit: Death due to Animal, Insect & Reptile Attack Benefit


in the Policy Certificate if the Insured Person suffers an Injury due to an Accident caused by bite, attack

and/or sting of an animal, reptile or insect through direct violent skin contact that occurs during the Period

of Cover and that Injury solely and directly results in the Insured Person’s death within 365 days from the

date of the Accident.

We will pay the Sum Insured if the Insured Person suffers an Injury due to an Accident caused by bite or

attack of an animal through direct violent skin contact that occurs during the Period of Cover and that Injury

results in the Insured Person contracting rabies which solely and directly results in the Insured Person’s

death within 365 days from the date of the Accident. On the acceptance of a claim under this Benefit and

any other applicable Benefit pertaining to the same event, all cover under this Policy in respect of the

Insured Person shall immediately and automatically cease.

B.2 Basic Benefit: Permanent Total Disablement (PTD) due to Animal, Insect & Reptile Attack

Benefit


in the Policy Certificate if the Insured Person suffers an Injury due to an Accident caused by bite, attack

and/or sting of an animal, reptile or insect through direct violent skin contact that occurs during the Period

of Cover and that Injury solely and directly results in the Insured Person’s Permanent Total Disablement

within 120 days from the date of the Accident.


i. If the Insured Person suffers Injuries resulting in more than one Permanent Total Disablement, then Our maximum, total and cumulative liability under this Benefit shall be limited to the Sum Insured.

ii. If We have admitted a claim for Permanent Total Disablement in accordance with this Benefit, then We shall not be liable to make any payment under the Policy on the death of the Insured Person, if the Insured Person subsequently dies.

iii. We will only accept one claim under this Benefit in the lifetime of the Insured Person. On the acceptance of a claim under this Benefit, all cover under this Benefit and under Benefit A.2 in respect of the Insured Person shall immediately and automatically cease but insurance cover under any other applicable Benefits under this Policy whether in the present Period of Cover or any subsequent Period of Cover shall continue subject to the availability of the Sum Insured and the terms, conditions and exclusions of the Policy.

B.3 Extension: Hospitalization Expenses due to Animal, Insect & Reptile Attack

Reimbursement Benefit


31

We will reimburse the Medical Expenses incurred if the Insured Person suffers an Injury due to an

Accident caused by bite, attack and/or sting of an animal, reptile or insect through direct skin contact that

occurs during the Period of Cover and that Injury solely and directly results in the Insured Person’s

Hospitalization within 7 days from the date of the Accident.



ii. We will reimburse only those Medical Expenses that are Reasonable and Customary Charges.

iii. We shall not be liable to make any payment in respect of any non-payable items, the list of which is attached to this Policy and is available on Our website www.icicilombard.com].

iv. Expenses incurred towards treatment in any hospital or by any Medical Practitioner or

any other provider specifically excluded by the Insurer and disclosed in its website / notified to the policyholders are not admissible. However, in case of life threatening situations or following an accident, expenses up to the stage of stabilization are payable but not the complete claim.

v. Our liability to make any payment under this Benefit shall be in excess of the per event Deductible or per event Franchise stated in the Policy Certificate, if applicable.

vi. If a claim is accepted under this Benefit in respect of an Insured Person and the amount due under this claim and claims already admitted under the Benefit in respect of the Insured Person will cumulatively lead to the Sum Insured being exceeded then Our maximum, total and cumulative liability under any and all such claims will be limited to the Sum Insured.

vii. If We have admitted a claim under this Benefit, then on the Insured Person/Nominee’s advance written request, We will pay the amount due under this Benefit directly to the Hospital where the Insured Person was treated.

EXCLUSIONS AND LIMITATIONS APPLICABLE TO SECTION B

We shall not be liable to make any payment for any claim under Section B of this Policy in respect of an


following:

a. Any Injury sustained while working professionally with any animals reptiles or insects.

b. Any Injury or Illness of any kind caused or infected by or transmitted by or in any way attributed

to virus, parasite, bacteria or any microorganism including where the virus, parasite, bacteria or

any other microorganism is introduced and/ or caused by bites of insects, reptiles, animals and/or

other vector.

c. War, invasion, act of foreign enemy hostilities or warlike operations (whether war be declared or


kinds and political gatherings, police, military, naval or air service, engaging in aviation other than

as a passenger (fare paying or otherwise) in any licensed standard type of aircraft.

d. Breach of law or being involved in any unlawful activity

e. Any Injury / Illness arising from intentional self- Injury, suicide or attempted suicide.


32

f. Any Injury / Illness arising whilst under the influence of alcohol or intoxicating drugs or substance

abuse of any kind.

g. Any Injury that has occurred prior to the commencement of Period of Cover whether or not the

same has been treated, or medical advice, diagnosis, care or treatment has been sought. Any

Illness, complication or ailment arising out of or connected to such Injury.

h. Death, disablement (whether of a permanent nature or of a temporary nature), Injury, Illness or

Hospitalization arising from or caused by ionizing radiation or contamination by radioactivity from

any nuclear fuel (explosive or hazardous form) or resulting from or from any other cause or event

contributing concurrently or in any other sequence to the loss, claim or expense from any nuclear

waste from the combustion of nuclear fuel, nuclear, chemical or biological attack.

i. Any Injury or Illness occurring whilst engaging in any Adventure Sports.

EXCLUSIONS AND LIMITATIONS APPLICABLE TO SECTION B.3

We shall not be liable to make any payment for any claim under Section B.3 of this Policy in respect of an


following:

1.

Maternity (Code – Excl 18) –

i. Medical treatment expenses traceable to childbirth (including complicated deliveries and

caesarean sections incurred during hospitalization) except ectopic pregnancy;

ii. Expenses towards miscarriage (unless due to an accident) and lawful medical termination

of pregnancy during the policy period.

2. Circumcision or strictures, vaccination, inoculation, intentional self-Injury, dissipation, nervous

breakdown (which expression shall cover also general debility, "run down" conditions and

"general overhaul"), venereal disease, intemperance, or any diseases, Injury, death or

disablement directly or indirectly due to any one or more of them.

3. Change of gender treatments (Code – Excl 07) - Expenses related to any treatment, including

surgical management, to change characteristics of the body to those of the opposite sex.

4. Cosmetic/Plastic surgery (Code – Excl 08) - Expenses for cosmetic or plastic surgery or any

treatment to change appearance unless for reconstruction following an Accident, Burn(s) or

Cancer or as part of medically necessary treatment to remove a direct and immediate health risk

to the insured. For this to be considered a medical necessity, it must be certified by the attending

Medical Practitioner

5. Treatment for, Alcoholism, drug or substance abuse or any addictive condition and

consequences thereof (Code – Excl 12)

6. Dental treatment, eye treatment unless necessitated as a consequence of an Injury.


33

7. Any Hospitalization not arising out of an Injury.

8. Any Medical Expenses not incurred in a Hospital.

9. Hazardous or Adventure Sport (Code – Excl 09) - Expenses related to any treatment necessitated

due to participation as a professional in hazardous or adventure sports, including but not limited

to, para-jumping, rock climbing, mountaineering, rafting, motor racing, horse racing or scuba

diving, hand gliding, sky diving, deep-sea diving.

10. Rest Cure, rehabilitation and respite care (Code – Excl 05) - Expenses related to any admission

primarily for enforced bed rest and not for receiving treatment. This also includes:

i. Custodial care either at home or in a nursing facility for personal care such as help with

activities of daily living such as bathing, dressing, moving around either by skilled nurses

or assistant or non-skilled persons.

ii. Any services for people who are terminally ill to address physical, social, emotional and

spiritual needs.

11. Breach of Law (Code – Excl 10)- Expenses for treatment directly arising from or consequent upon

any Insured Person committing or attempting to commit a breach of law with criminal intent

12. Excluded providers (Code – Excl 11) - Expenses incurred towards treatment in any hospital or by

any Medical Practitioner or any other provider specifically excluded by the Insurer and disclosed

in its website/notified to the policyholders are not admissible. However, in case of life threatening

situations or following an accident, expenses up to the stage of stabilization are payable but not

the complete claim.




14. Dietary supplements and substances that can be purchased without prescription, including but

not limited to Vitamins, minerals and organic substances unless prescribed by a medical

practitioner as part of hospitalization claim or day care procedure (Code – Excl 14)

15. Unproven Treatments (Code – Excl 16) - Expenses related to any unproven treatment, services



CLAIMS DOCUMENTS FOR SECTION B

On the occurrence of an Insured Event or discovery of any Injury which may give rise to a claim under

Section B of the Policy, We shall be provided with the following necessary and mandatory information and

documentation, specified in relation to the Benefit being claimed within 30 days of the occurrence of the

Insured Event:


34

S.

No

.

. B

en

efi

t N

am

e

ML

C o

r F

IR

Ca

us

e o

f D

eath

Ce

rtif

icate

Po

st

Mo

rtem

Re

po

rt

Vic

era

/

Ch

em

ical

An

aly

sis

/

Fo

ren

sic

Re

po

rt

Po

lic

e F

inal

Ch

arg

e S

he

et

/

Co

urt

Fin

al

Ord

er

Sp

ot

/ In

qu

est

Pa

nc

hn

am

a

Dis

ab

ilit

y

Ce

rtif

icate

Ind

oo

r c

as

e

pap

ers

Me

dic

al

Ce

rtif

icate

Dis

ch

arg

e

Su

mm

ary

Co

mp

lete

ho

sp

ital

bills

B.1

Death

due to

Animal ,

Insect

and

Reptile

Attack

Benefit

B.2

PTD

due to

Animal,

Insect

and

Reptile

Attack

Benefit

B.3

Hospita

lization

Expens

es due

to

Animal,I

nsect &

Reptile

Attack

Benefit


35

SECTION C: SPECIFIC VECTOR BORNE DISEASE OR MALARIA BENEFIT

SECTION C.1: Specific vector borne disease Benefit

Benefit C.1.1: Basic Benefit: Specific Vector Borne Disease related Hospitalization Benefit

We will pay the Sum Insured specified against this Benefit in the Policy Certificate if an Insured Person is

diagnosed with a Specific Vector Borne Disease that solely and directly requires the Insured Person to be

Hospitalized during the Period of Cover.


i. The Hospitalization is for Medically Necessary Treatment of the Specific Vector Borne Disease and is commenced and continued on the written advice of the treating Medical Practitioner.

ii. The Insured Person’s stay in the Hospital should continue for a minimum period of 48 successive hours.

iii. We shall not be liable to make any payment under this Benefit, if the Insured Person is first Hospitalized prior to the commencement of the Period of Cover.

iv. We shall not be liable to make any payment under this Benefit, if the Insured Person is Hospitalized due to Specific Vector Borne Disease within a period of 30 days from the commencement of the Period of Cover. This exclusion shall cease to apply from the first Renewal of the Insured Person’s cover under the Policy with Us.

v. We shall not be liable to make any payment under this Benefit in respect of Pre-hospitalization Medical Expenses or Post-hospitalization Medical Expenses.


vii. We will only accept one claim under this Benefit during the Period of Cover in respect of the Insured Person. On the acceptance of a claim under this Benefit, all cover under this Benefit in respect of the Insured Person shall immediately and automatically cease but insurance cover under any other applicable Benefits under this Policy during the Period of Cover shall continue subject to the availability of the Sum Insured and the terms, conditions and exclusions of the Policy.

CLAIMS DOCUMENTS FOR SECTION C.1

On the occurrence of an Insured Event or diagnosis of any Specific Vector Borne Disease which may give rise

to a claim under Section C.1 of the Policy, We shall be provided with the following necessary and mandatory

information and documentation specified mandatorily, in relation to the Benefit being claimed within 30 days of

the Insured Event:


S.No.

Benefit

Documents common for all specific

vector borne disease

Specific reports signed and attested by registered pathologist which confirm following diagnosis and laboratory

findings positively

Dengue Chickunguny

a Kala-Azar

Japanese encephalitis

Filariasis


36

C1.1

Specific vector borne disease related Hospitalization Benefit

Duly filled claim form

NS1 antigen test or Ig M- Elisa test

Presence of IgM and IgG anti chikungunya antibodies.

Direct Agglutination Test or Rapid dipstick test or ELISA for detecting IgG

Ig M antibody detection in serum or cerebrospinal fluid

Antigen detection in blood sample or IgG4 antibody detection using routine assays

Out-patient consultation paper

Anemia, Leucopenia, thrombocytopenia and Hypergammaglobulinemia

Hospital Discharge summary duly signed and attested by treating doctor confirming the diagnosis

Indoor case papers of treating hospital


37

SECTION C.2: Malaria Benefit

Benefit C.2.1: Basic Benefit: Malaria related Hospitalization Benefit

We will pay the Sum Insured specified against this Benefit in the Policy Certificate if an Insured Person is

diagnosed with Malaria that solely and directly requires the Insured Person to be Hospitalized during the Period

of Cover.


i. The Hospitalization is for Medically Necessary Treatment of Malaria and is commenced and continued on the written advice of the treating Medical Practitioner.

ii. The Insured Person’s stay in Hospital should continue for a minimum period of 48 successive hours

iii. We shall not be liable to make any payment under this Benefit, if Hospitalization due to Malaria is prior to the commencement of the Period of Cover.

iv. We shall not be liable to make any payment under this Benefit, if hospitalization due to Malaria is within a period of 30 days from the commencement of the Period of Cover. This exclusion shall cease to apply from the first Renewal of the Insured Person’s cover under the Policy with Us.

v. We shall not be liable to make any payment under this Benefit in respect of Pre-hospitalization Medical Expenses or Post-hospitalization Medical Expenses.


vii. We will only accept one claim under this Benefit during the Period of Cover in respect of the Insured Person. On the acceptance of a claim under this Benefit, all cover under this Benefit in respect of the Insured Person shall immediately and automatically cease but insurance cover under any other applicable Benefits under this Policy during the Period of Cover shall continue subject to the availability of the Sum Insured and the terms, conditions and exclusions of the Policy.


On the occurrence of an Insured Event or diagnosis of Malaria which may give rise to a claim under Section C.2

of the Policy, We shall be provided with the following necessary and mandatory information and documentation,

specified in relation to the Benefit being claimed within 30 days of the Insured Event.

CLAIMS DOCUMENTS FOR SECTION C2.1


38

C2.

1

Malaria

related

Hospitali

zation

Benefit

Claim

form

Diagnosis must be

confirmed

positive/reactive by

microscopy or

malaria rapid

diagnostic test

(RDT) signed and

attested by

registered

pathologist

Treating doctor

certificate(duly filled

and attested)

confirming diagnosis

as Malaria

Outpatient

consultation

paper

(wherever

applicable)

Hospital

discharge

summary

In door

case

papers

of the

hospital


39

SECTION D – Basic Benefit: Maternal Complication Benefit We will pay the percentage of the Sum Insured (specified against this Benefit in the Policy Certificate) which is

specified in the table below if an Insured Person suffers one or more of the medical complications (of the nature

listed below) during maternity during the Period of Cover:

Sr. No. Maternal Complication % of Sum Insured

payable

1 Eclampsia 100%

2 Abruptio Placenta 100%

3 Placenta Increta 100%

4 Placenta Percreta 100%

5 Amniotic Fluid Embolism 100%

6 Acute Fatty Liver of Pregnancy 100%

7 Disseminated Intravascular Coagulation 100%

8 Still Birth 50%

9 Pre Eclampsia 25%

10 Hyperemesis Gravidarum requiring stay in Hospital

as an in patient for at least 48 successive hours 5%

11 Ectopic Pregnancy 25%

12

Any other maternal complication subject to

applicable exclusions specified under this section

requiring stay in Hospital as an in patient for at least

48 successive hours

25%

For the purpose of this Policy the maternal complications listed above shall have the following meanings:

1. Eclampsia means a life threatening pregnancy complication that causes a pregnant woman, usually

previously diagnosed with preeclampsia (high blood pressure and protein in the urine), to

develop seizures or coma.

2. Abruptio Placenta means premature separation of the placenta from the wall of the uterus

3. Placenta Increta means a condition in which part or all of the placenta remains firmly attached and

invades the muscles of the uterus

4. Placenta Percreta means a condition in which part or all of the placenta remains firmly attached and

grow through the uterine wall

5. Amniotic Fluid Embolism means an obstetric complication in which amniotic fluid, enters the blood

stream of the mother to trigger a cardio respiratory arrest and/or massive bleeding

https://www.emedicinehealth.com/preeclampsia/article_em.htm

https://www.emedicinehealth.com/high_blood_pressure/article_em.htm

https://www.emedicinehealth.com/wilderness_seizure/article_em.htm

https://www.emedicinehealth.com/coma/article_em.htm


40

6. Acute Fatty Liver of Pregnancy means potentially fatal complication of the liver that occurs in the third

trimester or early postpartum period caused by a disordered metabolism of fatty

acids by mitochondria in the mother

7. Disseminated Intravascular Coagulation means the pathological process characterized by the

widespread activation of the clotting cascade that results in the formation of blood clots in the small blood

vessels throughout the body.

8. Still Birth means baby born with no signs of life at or after 28 weeks' gestation

9. Pre Eclampsia means a pregnancy complication characterized by high blood pressure and signs of

damage to another organ system, most often the liver and kidneys associated with protienuria and which

usually begins after 20 weeks of pregnancy in women whose blood pressure had been normal prior to

the initiation of the pregnancy

10. Hyperemesis gravidarum is a pregnancy complication that is characterized by severe nausea,

vomiting, weight loss, and possibly dehydration.

11. Ectopic Pregnancy means a condition where a fertilized egg implants itself outside of the uterus


i. If the Insured Person dies undiagnosed before a claim has been admitted under this Benefit, then no amount will be payable under this Benefit, but We may consider a claim under any other applicable Benefits under the Policy.

ii. We shall not be liable to make any payment under this Benefit, if the maternal complication occurs or is first diagnosed prior to the commencement of the Period of Cover or within a period of 30 days from the commencement of the Period of Cover or after the completion of 30 days following the delivery. This exclusion of first 30 days from the period of commencement of cover shall cease to apply from the first Renewal of the Insured Person’s cover under the Policy with Us.

iii. If the Insured Person suffers more than one of the maternal complications specified in above, then Our maximum, total and cumulative liability under this Benefit shall be limited to the Sum Insured.

iv. If a claim is accepted under this Benefit in respect of an Insured Person and the amount due under this claim and claims already admitted under the Benefit in respect of the Insured Person will cumulatively lead to the Sum Insured being exceeded then Our maximum, total and cumulative liability under any and all such claims will be limited to the Sum Insured.

EXCLUSIONS AND LIMITATIONS APPLICABLE TO SECTION D:

We shall not be liable to make any payment for any claim under Section D of this Policy in respect of an Insured

Person, directly or indirectly for, caused by, arising from or in any way attributable to any of the following:

1. 30 day waiting period (Code – Excl 03) - Any Hospitalization falling within the Waiting Period

a. Expenses related to the treatment of any illness within the waiting period shall be excluded except

claims arising due to an accident, provided the same are covered.

b. This exclusion shall not, however, apply if the Insured Person has Continuous Coverage for more

than twelve months.

c. The within referred waiting period shall be applicable to the enhanced sum insured in the event

of granting higher sum insured subsequently

2. Sterility and Infertility (Code – Excl 17) - Expenses related to sterility and infertility.


41

This includes:

i. Any type of contraception, sterilization

ii. Assisted Reproduction services including artificial insemination and advanced

reproductive technologies such as IVF, ZIFT, GIFT, ICSI

iii. Gestational Surrogacy

iv. Reversal of sterilization.

3. Medical Termination of Pregnancy

4. Any claim arising on account of or in connection with any Neonatal Illness/condition

5. Any complication that has occurred prior to the commencement of Policy of Cover whether or not the


6. Any maternal complication arising out of a Pre-existing Disease (Code – Excl 01) -

a. Expenses related to the treatment of a pre-existing Disease (PED) and its direct complications

shall be excluded until the expiry of 24 months of continuous coverage after the date of inception

of the first policy with insurer.

b. In case of enhancement of sum insured the exclusion shall apply afresh to the extent of sum

insured increase.

c. If the Insured Person is continuously covered without any break as defined under the portability

norms of the extant IRDAI (Health Insurance) Regulations, then waiting period for the same would

be reduced to the extent of prior coverage

d. Coverage under the policy after the expiry of 24 months for any pre-existing disease is subject to

the same being declared at the time of application and accepted by Insurer.

7. Unproven Treatment (Code – Excl 16) - Expenses related to any unproven treatment, services and

supplies for or in connection with any treatment. Unproven treatments are treatments, procedures or

supplies that lack significant medical documentation to support their effectiveness.


a. Expenses related to any admission primarily for diagnostics and evaluation purposes only are

excluded;

b. Any diagnostic expenses which are not related or not incidental to the current diagnosis and

treatment are excluded.

9. Treatment by a Family Member and self-medication or any treatment that is not scientifically recognized.

10. Hazardous or Adventure Sport (Code – Excl 09) - Expenses related to any treatment necessitated due

to participation as a professional in hazardous or adventure sports, including but not limited to, para-

jumping, rock climbing, mountaineering, rafting, motor racing, horse racing or scuba diving, hand gliding,

sky diving, deep-sea diving.


42

11. Breach of Law (Code – Excl 10) - Expenses for treatment directly arising from or consequent upon any

Insured Person committing or attempting to commit a breach of law with criminal intent.

12. Excluded providers (Code – Excl 11) - Expenses incurred towards treatment in any hospital or by any

Medical Practitioner or any other provider specifically excluded by the Insurer and disclosed in its

website/notified to the policyholders are not admissible. However, in case of life threatening situations or

following an accident, expenses up to the stage of stabilization are payable but not the complete claim

13. Treatments received in heath hydros, nature cure clinics, spas or similar establishments or private beds

registered as a nursing home attached to such establishments or where admission is arranged wholly or

partly for domestic reasons. (Code – Excl 13)

14. Rest Cure, rehabilitation and respite care (Code – Excl 05) - Expenses related to any admission primarily

for enforced bed rest and not for receiving treatment. This also includes:





spiritual needs

CLAIMS DOCUMENTS FOR SECTION D

On the occurrence of an Insured Event which may give rise to a claim under Section D of the Policy, We shall

be provided with the following necessary and mandatory information and documentation specified in relation to

the Benefit being claimed within 30 days of the occurrence of the Insured Event:

Duly filled claim form

All medical and diagnostic reports including first USG report indicating the date of conception

Certificate from attending obstetrician clearly indicating the final diagnosis

Indoor case papers of treating Hospital

Hospital Discharge summary duly signed and attested by treating Medical Practitioner confirming the

diagnosis

Cause of death certificate filled and duly attested by Hospital

Any other document required by Us to assess the claim

SECTION E – HOSPITAL DAILY CASH - ILLNESS

E.1 Basic Benefit: Hospital Daily Cash Benefit

If an Insured Person contracts an Illness or suffers an Injury due to an Accident that occurs during the Period of

Cover and which solely and directly requires the Insured Person to be Hospitalized, then We will pay the daily

amount specified in the Policy Certificate for each continuous and completed day of Hospitalization.




43

ii. We shall not be liable to pay the daily amount for more than the maximum number of days specified in the Policy Certificate for each period of Hospitalization within the Period of Cover.

iii. Our liability to make any payment under this Benefit shall be in excess of the per event Deductible or per event Franchise stated in the Policy Certificate, if applicable.

iv. We shall not be liable to make any payment under this Benefit, if Hospitalization commenced prior to the commencement of the Period of Cover or within the waiting period specified in the Policy Certificate.

v. If a claim is accepted under this Benefit in respect of an Insured Person and the amount due under this claim and claims already admitted under the Benefit in respect of the Insured Person will cumulatively lead to the Sum Insured being exceeded then Our maximum, total and cumulative liability under any and all such claims will be limited to the Sum Insured.


E.2 Extension: Intensive Care Unit (ICU) Cash Benefit

If an Insured Person contracts an Illness or suffers an Injury due to an Accident that occurs during the Period of

Cover and which solely and directly requires the Insured Person to be Hospitalized in an Intensive Care Unit,

then We will pay the daily amount specified in the Policy Certificate for each continuous and completed day of

confinement in the Intensive Care Unit.


i. The Hospitalization in the Intensive Care Unit is for Medically Necessary Treatment and is commenced and continued on the written advice of the treating Medical Practitioner.

ii. We shall not be liable to pay the daily amount for more than the maximum number of days specified in the Policy Certificate for each period of Hospitalization within the Period of Cover.

iii. Our liability to make any payment under this Benefit shall be in excess of the Deductible stated in the Policy Certificate. However, the Deductible shall not apply to the extent of days in respect of which the Insured Person has already been admitted in the Hospital in a non- ICU room.

iv. We shall not be liable to make any payment under this Benefit, if Hospitalization commenced prior to the commencement of the Period of Cover or within the waiting period specified in the Policy Certificate.

v. If a claim is accepted under this Benefit in respect of an Insured Person and the amount due under this claim and claims already admitted under the Benefit in respect of the Insured Person will cumulatively lead to the Sum Insured being exceeded then Our maximum, total and cumulative liability under any and all such claims will be limited to the Sum Insured.


E.3 Basic Benefit: Emergency Medical Services Benefit

1. Emergency Ambulance Service Benefit

If the Insured Person suffers and Illness or sustains an Injury during the Period of Cover which requires

the Insured Person to be transported to Hospital in an emergency for Medically Necessary Treatment to

be rendered, We will pay for the Ambulance Charges incurred on a Cashless Facility basis only



44

i. The Ambulance Charges incurred are Reasonable and Customary Charges.

ii. The transportation is certified in writing to have been necessary by a Medical Practitioner.

iii. The medical condition of the Insured Person requires immediate Ambulance Services from the place where the Insured Person is Injured or is ill to a Hospital where appropriate medical treatment can be obtained or from the existing Hospital to another Hospital with advanced facilities as advised by the treating Medical Practitioner for management of the current Illness or Injury for which the service is called upon.

iv. The Ambulance Service will be offered by Our Service Providers on a Cashless Facility basis provided that the request has been made by the Insured Person or his Family Members on the dedicated helpline 18001028136 (Toll free) and 01244498770 (Charges applicable helpline number). This number if changed will be updated on Our website.

v. We will provide this Benefit only for a one way transfer from the place of Injury or Ilness to the nearest Hospital where necessary treatment facility is available or from one Hospital to another Hospital having advanced facilities.

vi. We will provide this Benefit only for road Ambulance Services availed within the same city.

vii. We will not make any payment under this Benefit if the Insured Person is transferred to any Hospital for evaluation purposes only or for any non-emergency services or if there is no active line of treatment.

viii. Ambulance coordination for emergency cases will be provided through the helpline of Our Service Provider on best effort basis from the communicated location by providing a valid identification for validation of coverage. A Medical Practitioner can accompany the BLS Ambulance or ALS Ambulance, as and when required and as per availability.

ix. The ambulance coordination is available 24*7, 365 days a year and within the jurisdiction of major cities as listed. The list of cities where this facility will be provided shall be available on the Our website.

x. We shall not be liable to pay for any reimbursement for use of an Ambulance Service by the Insured Person.

2. Tele consultation Benefit :

We will make available consultation with Medical Practitioners in case of need through Our service provider

helpline for assessing the case situation or routine health issues over the phone. Over the counter (OTC)

medicines may be prescribed/ suggested on case to case basis. The prescription / suggestion if given by

the Medical Practitioner will be based on the information provided by the Insured Person and interpreted by

the Medical Practitioner and We have no responsibility and owe no liability for any discrepancy in the

information given.

Features under this Benefit include:

24*7, 365 days a year availability


45

Consultations by Medical Practitioners

Over the counter (OTC) medicines may be prescribed/ suggested on case to

case basis

The Insured can reach the Medical Practitioner by calling on the dedicated

helpline number: +91 124 4498757. Any change in this helpline number shall

be updated on Our website www.icicilombard.com

3. Health Assistance Benefit

Health assistance will be provided through Our dedicated helpline. The health assistance team is

dedicated to assist the Insured Person in:

i. Identifying specialist/ Hospital

ii. Fixing an appointment with Medical Practitioners/nutritionist wherever applicable on best

effort basis

iii. Facilitation in getting a second opinion and fixing appointments with a Medical

Practitioner, wherever applicable. Any service availed by the Insured Person would be on

a paid basis and to payment will be made by the Insured Person directly to the Medical

Practitioner

iv. Providing options on suitable Network Providers.

v. Providing information on ailments and possible lines of treatment

The facilitation for assistance would be free for the Insured Person. However, the Medical Practitioner’s fees or

any other diagnostic services availed by the Insured Person would borne by the Insured Person and to be paid

directly to service providers i.e. Medical Practitioner, nutritionist or Hospital. Call Helpline no. 040 – 6627 4205

(9:30 am to 6 pm Mon to Fri, excluding public holidays) or write to [email protected] to avail

this facility. Any change in this helpline number shall be updated on Our website www.icicilombard.com

Any information provided through assistance cannot be used as a substitute for physical examination by a

Medical Practitioner.

General Conditions Applicable to Section E.3

Choosing any service is purely on customer’s discretion and at their own risk.

The prescription/suggestion will be based on the information provided and We hold no responsibility/ owe no

liability for any discrepancy in the information given. The Insured Person should seek assistance from a health

care professional when interpreting these materials and applying them to his/her individual circumstances. If the

Insured Person has any concerns about his/her health, he/she should consult his/her general practitioner.

By seeking and availing services under this Section the Insured Person is not prohibited or advised against

visiting or consulting with any other independent Medical Practitioner or commencing or continuing any treatment

advised by such Medical Practitioner.

mailto:[email protected]


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The Insured Person is free to choose whether or not to obtain services under this Section, and, if obtained, then

whether or not to act on the advice received in whole or in part.

The services obtained under this Benefit shall be shall me provided on best effort basis and be limited to defined

criteria and shall not be valid for any medico legal purposes.

Annexure A: List of cities where Ambulance Service will be available

Mumbai/Navi Mumbai & Thane, Pune, Delhi/NCR, Chandigarh, Indore , Ahmedabad, Vadodara, Goa, Jaipur,

Kochi, Lucknow, Vijaywada, Mysore, Bhopal, Bangalore, Chennai, Hyderabad, Kolkata, Vishakhapatnam,

Bhubaneswar, Meerut, Guwahati, Nasik, Aurangabad, Guntur & Coimbatore.

The above mentioned list is for locations where this service is currently active. However, this is subject to change

and the updated list shall be available on Our website www.icicilombard.com.

EXCLUSIONS AND LIMITATIONS APPLICABLE TO SECTION E

We shall not be liable to make any payment for any claim under Section E of this Policy in respect of an Insured

Person, directly or indirectly for, caused by, arising from or in any way attributable to any of the following:

1. Any Hospitalization falling within the Waiting Period as specified in the Policy Certificate subject

to maximum 30 days waiting period.

30 day waiting period (Code – Excl 03) -

1. Expenses related to the treatment of any illness within the 30 days / waiting period as mentioned

in the policy certificate, shall be excluded except claims arising due to an accident, provided the

same are covered.

2. This exclusion shall not, however, apply if the Insured Person has Continuous Coverage for more

than twelve months.

3. The within referred waiting period shall be applicable to the enhanced sum insured in the event

of granting higher sum insured subsequently

2. Pre-existing Diseases (Code – Excl 01) - (Unless specifically covered and mentioned in the policy

certificate)

1. Expenses related to the treatment of a pre-existing Disease (PED) and its direct complications

shall be excluded until the expiry of 24 months of continuous coverage after the date of inception

of the first policy with insurer.

2. In case of enhancement of sum insured the exclusion shall apply afresh to the extent of sum

insured increase.

3. If the Insured Person is continuously covered without any break as defined under the portability

norms of the extant IRDAI (Health Insurance) Regulations, then waiting period for the same would

be reduced to the extent of prior coverage


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4. Coverage under the policy after the expiry of 24 months for any pre-existing disease is subject to

the same being declared at the time of application and accepted by Insurer.

3. All dental treatment or dental surgery of any kind unless necessitated due to an Accident

4. Unproven Treatment (Code – Excl 16) - Expenses related to any unproven treatment, services



5. Any treatment received outside India unless specifically covered and specified in the Policy

Certificate.

6. Circumcision unless necessary for treatment of an underlying disease.

7. Maternity (Code – Excl 18) - (Unless specifically covered and mentioned in the policy certificate)

1. Medical treatment expenses traceable to childbirth (including complicated deliveries and

caesarean sections incurred during hospitalization) except ectopic pregnancy;

2. Expenses towards miscarriage (unless due to an accident) and lawful medical termination of

pregnancy during the policy period;

8. Sterility and Infertility (Code – Excl 17) - Expenses related to sterility and infertility.

This includes:

1. Any type of contraception, sterilization

2. Assisted Reproduction services including artificial insemination and advanced

reproductive technologies such as IVF, ZIFT, GIFT, ICSI

3. Gestational Surrogacy

4. Reversal of sterilization.

9. Routine medical, dental, eye and ear examinations is not covered unless specifically covered and

specified in the Policy Certificate.

10. Cosmetic or Plastic Surgery (Code – Excl 08) - Expenses for cosmetic or plastic surgery or any

treatment to change appearance unless for reconstruction following an Accident, Burn(s) or

Cancer or as part of medically necessary treatment to remove a direct and immediate health risk

to the insured. For this to be considered a medical necessity, it must be certified by the attending

Medical Practitioner.

11. Refractive Error (Code – Excl 15) - Expenses related to the treatment for correction of eye sight

due to refractive error less than 7.5 dioptres.


1. Expenses related to any admission primarily for diagnostics and evaluation purposes only

are excluded;


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2. Any diagnostic expenses which are not related or not incidental to the current diagnosis

and treatment are excluded.

13. Treatment of general debility, convalescence, run-down condition or rest cure, venereal disease.

14. Obesity / Weight Control (Code – Excl 06) -: Expenses related to the surgical treatment of obesity

that does not fulfil all the below conditions:

1. Surgery to be conducted is upon the advice of the Doctor

2. The surgery/Procedure conducted should be supported by clinical protocols

3. The member has to be 18 years of age or older and

4. Body Mass Index (BMI);

1. greater than or equal to 40 or

2. greater than or equal to 35 in conjunction with any of the following severe co-

morbidities following failure of less invasive methods of weight loss:

1. Obesity-related cardiomyopathy

2. Coronary heart disease

3. Severe Sleep Apnea

4. Uncontrolled Type2 Diabetes

15. Intentional self Injury, suicide or attempt to suicide.


same has been treated, or medical advice, diagnosis, care or treatment has been sought. Any

Illness, complication or ailment arising out of or connected to such Injury.

17. Any external congenital anomalies.




from or traveling in any balloon or aircraft other than as a passenger (fare-paying or otherwise) in

any scheduled airline anywhere in the world

19. Change of Gender Treatments (Code – Excl 07) - Expenses related to any treatment, including

surgical management, to change characteristics of the body to those of the opposite sex.

20. Treatment by a Family Member and self-medication or any treatment that is not scientifically

recognized.

21. Hazardous or Adventure Sports (Code – Excl 09) - Expenses related to any treatment

necessitated due to participation as a professional in hazardous or adventure sports, including


49

but not limited to, para-jumping, rock climbing, mountaineering, rafting, motor racing, horse racing

or scuba diving, hand gliding, sky diving, deep-sea diving.

22. Breach of Law (Code – Excl 10) - Expenses for treatment directly arising from or consequent

upon any Insured Person committing or attempting to commit a breach of law with criminal intent.

23. Treatment for, Alcoholism, drug or substance abuse or any addictive condition and consequences

thereof. (Code – Excl 12)




25. Dietary supplements and substances that can be purchased without prescription, including but

not limited to Vitamins, minerals and organic substances unless prescribed by a medical

practitioner as part of hospitalization claim or day care procedure (Code – Excl 14)



kinds and political gatherings, police, military, naval or air service, engaging in aviation other

than as a passenger (fare paying or otherwise) in any licensed standard type of aircraft.

27. Death, disablement (whether of a permanent nature or of a temporary nature), Injury, Illness or

Hospitalization arising from or caused by ionizing radiation or contamination by radioactivity

from any nuclear fuel (explosive or hazardous form) or resulting from or from any other cause or

event contributing concurrently or in any other sequence to the loss, claim or expense from any

nuclear waste from the combustion of nuclear fuel, nuclear, chemical or biological attack.

28. Excluded providers (Code – Excl 11) - Expenses incurred towards treatment in any hospital or

by any Medical Practitioner or any other provider specifically excluded by the Insurer and

disclosed in its website/notified to the policyholders are not admissible. However, in case of life

threatening situations or following an accident, expenses up to the stage of stabilization are

payable but not the complete claim.

29. Rest Cure, rehabilitation and respite care (Code – Excl 05) -

Expenses related to any admission primarily for enforced bed rest and not for receiving

treatment. This also includes:





spiritual needs.

30. Specific disease/procedure Waiting Period (Code – Excl 02) - (Unless specifically covered

and mentioned in the policy certificate):


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Expenses related to the treatment of the below listed Conditions, surgeries/treatments shall be

excluded until the expiry of 24 months of continuous coverage after the date of inception of the

first policy with us. This exclusion shall not be applicable for claims arising due to an accident.

In case of enhancement of sum insured the exclusion shall apply afresh to the extent of sum

insured increase.

If any of the specified disease/procedure falls under the waiting period specified for pre-Existing

diseases, then the longer of the two waiting periods shall apply.

The waiting period for listed conditions shall apply even if contracted after the policy or declared

and accepted without a specific exclusion.

If the Insured Person is continuously covered without any break as defined under the applicable

norms on portability stipulated by IRDAI, then waiting period for the same would be reduced to

the extent of prior coverage.

List of such specific diseases/procedures

i. Deviated Nasal Septum, CSOM-Chronic Suppurative Otitis Media ii. Stapedectomy, Mastoidectomy, any treatment for conditions related to tonsils, adenoids,

sinuses, turbinates/ concha iii. Fibroids (fibromyoma), Endometriosis, Uterine Prolapse, Polycysyic Ovarian

Syndrome(PCOS) iv. Dilatation and curettage (D&C), Myomectomy, Hysterectomy v. Arthritis, Gout and Rheumatism vi. Stones in gall bladder & Biliary System; Cholecystitis, Fissure/fistula in anus, hemorrhoids,

pilonidal sinus, piles, Esophageal Varices & Gastric Varices, Gastritis, Duodenitis & Pancreatitis

vii. Gastric & Duodenal ulcers, Gastro Esophageal Reflux Disorder (GERD)/Acid Peptic Disease, Ulcerative colitis, Crohn's disease, Irritable Bowel Syndrome, Inflammatory Bowel disease

viii. All forms of cirrhosis, Rectal prolapse, Perineal Abscesses, Perianal Abscesses ix. Cholecystectomy, Endoscopy x. Stones in Urinary system, all prostate diseases, chronic renal failure or end stage renal failure

or chronic kidney disease, dialysis xi. Dysfunctional uterine bleeding, pelvic inflammatory diseases, stress incontinence, Hydrocele,

varicocele/ rectocele/ spermatocele xii. Cataract, Glaucoma, Diseases of the vitreous and retina xiii. Unless malignant, All Internal/ External tumors, cysts, nodules, polyps, sinus, fistula, adenoma,

lumps including teratoma, breast lumps, dermoid cyst, ovarian cyst, desmoid tumour, umblical granuloma, mucous cyst of lip/cheek

xiv. Diseases related to thyroid xv. All skin ailments xvi. Ulcers of any kind (whether internal or external) including decubitus ulcers xvii. Varicose veins & Varicose ulcers xviii. Intervertebral disc disorders , Arthroscopy, Spinal and Vertebral Disorders including diagnosis

as low back ache, Surgeries for joint replacements (except if hospitalization is required due to an accidental injury)

xix. All Hernias (except if Hospitalization is required due to an Injury)

Claim Documents for Section E (Applicable for Benefit E.1 and E.2)


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1. On the occurrence of an Insured Event which may give rise to a claim under Section E of the Policy, We

shall be provided with the following necessary and mandatory information and documentation specified

in relation to the Benefit being claimed within 30 days of the occurrence of the Insured Event: Duly filled

claim form

2. Indoor case papers from the Hospital mentioning the diagnosis, date and time of admission and

discharge, past medical and surgical history with duration.

3. Hospital Discharge summary filled and attested by Hospital

4. First Information Report (F.I.R.) copy / Medico-legal case papers - Notarized/ Attested by a gazetted

officer in case of an Injury

BASIS OF ASSESSMENT OF CLAIM

The fulfillment of the terms and conditions of this Policy (including payment of premium by the due dates

mentioned in the Policy Schedule) insofar as they relate to anything to be done or complied with by You or any

Insured Person, including complying with the procedures and requirements in relation to claims, shall be

Conditions Precedent to Our liability under this Policy.

We shall be under no obligation to make any payment under this Policy unless We have received all premium

payments in full and on time in respect of the Insured Person’s cover under the Policy and all payments have

been realised.

We shall be given notice of any event that may give rise to a claim on toll free number 1800 2666 or on our

website www.icicilombard.com or also in writing at Our address specified in the Policy Certificate:

All claims shall be made within the timelines and in accordance with the procedures set out in the relevant

Sections of the Policy. All claims documentation specified within the relevant Section of the Policy for the Benefit

being claimed must be submitted in full.

If any claim is not made within 30 days of the Insured Event, then We will condone such delay on merits only

where the delay has been proved to be for reasons beyond the claimant’s control.

We/Our representatives must be given all reasonable co-operation in investigating the claim in order to assess

Our liability and quantum in respect of such claim. If requested by Us and at Our cost, the Insured Person must

submit to medical examination by Our nominated Medical Practitioner as often as We consider reasonable and

necessary and We/Our representatives must be permitted to inspect the medical and Hospitalization records

pertaining to the Insured Person’s Injury/Illness and treatment and to investigate the facts surrounding the claim.

Our medical or other representative shall be allowed to examine the Insured Person on the occurrence of any

alleged Injury or disablement when and as often as the same may reasonably be required on behalf of Us and

in the event of death to make a post-mortem examination of the body of the Insured Person. Such evidence as

We may require from time to time shall be furnished and a post-mortem examination report, be furnished within

a period of thirty days.

The directions, advice and guidance of the treating Medical Practitioner shall be strictly followed. We shall not

be obliged to make any payments that are brought about or contributed to as a consequence or failure to follow

such directions, advice or guidance.

http://www.icicilombard.com/


52

We shall make the payment of claim that has been admitted as payable by Us under the Policy within 30 days

of submission of the last necessary documents and information required for the settlement of the claim. All

claims will be investigated (as required) and settled in accordance with the applicable regulatory guidelines,

including the IRDAI (Protection of Policyholders Interests) Regulations, 2017.

In case the customer has chosen for claim payout on a pre-determined periodic installment basis, he/she shall

not be able to change such claim payment terms within the Policy Period and/or at the time of a claim.

In case of delay in payment of any claim that has been admitted as payable by Us under the Policy, beyond the

time period as prescribed under IRDAI (Protection of Policyholders Interests) Regulations, 2017, We shall pay

interest at a rate which is 2% above the bank rate where “bank rate” shall mean the bank rate fixed by the

Reserve Bank of India at the beginning of the financial year in which claim has fallen due.

NOTE:-

Please inform us immediately of any change in the address, occupation, state of health, or of any other changes

affecting the Insured Person (or his Nominee/ legal heir, as the case may be)

The scope of cover shall be within the geographical boundaries on India unless specified otherwise.

Terms of Renewal

The Policy may be renewed by mutual consent and in such event the Renewal premium should be paid

to Us on or before the date of expiry of the Policy and in no case later than the Grace Period of 30 days

from the expiry of the Policy. We will not be liable to pay for any claim arising out of an Injury or Accident

or Illness or Hospitalization that occurred during the Grace Period.

For Sections C, D and E renewals will not be denied except on grounds of misrepresentation, moral

hazard, fraud, non-disclosure of material facts. However, the maximum renewal age for Section D shall

be 40 years. We may, revise the Renewal premium payable under the Policy or the terms of cover,

provided that all such changes are approved in accordance with the IRDAI rules and regulations as

applicable from time to time. Renewal premium will not alter based on individual claims experience. We

will intimate You of any such changes at least 3 months prior to date of such revision or modification.

You shall on tendering any premium for the Renewal of this Policy give notice in writing to Us of any

disease, physical defect or infirmity with which any of the Insured Person(s) have become affected since

the payment of the expiring Policy start date.

If this product is withdrawn with the IRDAI’s approval, then the Policy may be renewed under the nearest

substitute product available.

POLICY RELATED TERMS AND CONDITIONS

Proof satisfactory to Us shall be furnished of all matters upon which a claim is based. Any medical or other agent of Us shall be allowed to examine the Insured Person(s) on the occasion of any alleged Injury or disablement when and as often as the same may reasonably be required on behalf of Us and in the event of death to make a post-mortem examination of the body of the Insured Person. Such evidence as We may from time to time require shall be furnished and a post-mortem examination report, be furnished within a period of thirty days.


53

You shall give immediate notice to Us of any change in any of the business or occupation of the Insured Person.

Any change in the policy terms and conditions including but not limited to sum insured and/or coverage shall will not be permitted within the Period of Cover.

In case the customer chooses to pay the premium in installments then he/she shall not be able to change the frequency of payments within the Period of Cover.

In case the customer has opted for auto renewal, the policy shall be Renewed with the same policy terms & conditions including but not limited to the sum insured, coverage, premium paying terms and claim payment terms and policy terms & conditions.

We shall make payment to assignee/partial assignee/conditional assignee, as the case may be or in the

absence of assignee to the Insured Person or the Insured Person’s nominee. If there is no assignee or

nominee and the Insured Person is incapacitated or deceased, We will pay to the Insured Person’s heir,

executor or validly appointed legal representative. Any payment We make in this manner will be a

complete and final discharge of Our liability towards the claim.

For Section C, D and E, the Insured Person shall have the right to migrate from this Policy to a similar individual health insurance policy, if available with Us.

PART III OF THE POLICY SCHEDULE

STANDARD TERMS AND CONDITIONS

1. Incontestability and Duty of Disclosure

The Policy shall be null and void and no benefit shall be payable in the event of untrue or incorrect statements,

misrepresentation, mis-description or on non-disclosure in any material particular in the proposal form, personal

statement, declaration and connected documents, or any material information having been withheld, or a claim

being fraudulent or any fraudulent means or devices being used by the Insured Person or any one acting on his

behalf to obtain any benefit under this Policy.

Proof satisfactory to the Company shall be furnished of all matters upon which a claim is based.

2. Change in Policy

Any change in the Policy terms and conditions including but not limited to Sum Insured and/or coverage shall

not be permitted within the Policy Period. In case the customer chooses to pay the premium in installments then

he/she shall not be able to change the frequency of payments within the Policy Period.

3. Material change

The Insured Person shall immediately notify the Company in writing of any material change in the risk and cause

at his own expense such additional precautions to be taken as circumstances may require to ensure safe

operation, trade or business practices thereby containing the circumstances that may give rise to the claim and

We may, adjust the scope of cover and / or premium, if necessary, accordingly.

4. Records to be maintained

The Insured Person shall keep an accurate record containing all relevant particulars and shall allow Us to inspect

such record.


54

5. Notice of Charge

We shall not be bound to take notice or be affected by any notice of any trust, charge, lien, assignment or other

dealing with or relating to this Policy, but the payment by Us to the Insured Person, Nominee, assignee or his

legal heirs of any amount under the Policy shall in all cases be an effectual discharge to Us.

6. Overriding effect of Policy Certificate

The terms and conditions contained herein and in the Policy Certificate shall be deemed to form part of the

Policy and shall be read as if they are specifically incorporated herein; however in case of any inconsistency of

any term and condition with the scope of cover contained in the Policy Certificate, then the term(s) and

condition(s) contained herein shall be read mutatis mutandis with the scope of cover/terms and conditions

contained in the Policy Certificate and shall be deemed to be modified accordingly or superseded in case of

inconsistency being irreconcilable.

7. Fraudulent claims

If any claim is in any manner dishonest or fraudulent, or is supported by any dishonest or fraudulent means or

devices, whether by You or any Insured Person or anyone acting on behalf of You or an Insured Person, then

this Policy/Certificate of Insurance will be void and all benefits otherwise payable under it will be forfeited.

8. Free Look Period

You have a period of 15 days (30 days if the Policy is sold through distance marketing) from the date of receipt

of the Policy document to review the terms and conditions of this Policy. If You have any objections to any of

the terms and conditions, You have the option of cancelling the Policy stating the reasons for cancellation and

You will be refunded the premium paid by You after adjusting the amounts spent on any medical check-up,

stamp duty charges and proportionate risk premium. You can cancel Your Policy only if no claims have been

made under the Policy. All Your rights under this Policy will immediately stand extinguished on the free look

cancellation of the Policy. Free look provision is not applicable and available at the time of Renewal of the Policy.

Free Look Period is applicable only on first purchase of the policy and is not applicable on any Renewals.

9. Cancellation/ Termination

a) Disclosure to information norm:

The Policy shall be void and all premium paid hereon shall be forfeited to Us, in the event of misrepresentation,

mis-description or non-disclosure of any material fact.

You may also give 15 days notice in writing, to Us, for the cancellation of this Policy, in which case We shall

from the date of receipt of notice cancel the Policy and refund the premium for the period this Policy has been

in force as per the refund grid applicable.

b) Refund Grid applicable to Policies having Policy Period lesser than or equal to 1 year:

Day of cancellation Rate of Premium refunded

Within 30 days 70%

31 – 90 days 60%


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91 days – 6 months 45%

Exceeding 6 months Nil

c) Refund Grid Applicable to policies having Policy Period greater than 1 year:

% of Premium refund

Day of cancellation Policy Period

2 years 3 years 4 years 5 years

Within 180 days 60% 65% 70% 75%

181 – 365 days 40% 52% 57% 61%

366 – 730 days

NIL

26% 38% 46%

731 – 1095 days NIL

20% 30%

1096 – 1460 days NIL 15%

More than 1460 days NIL

Notwithstanding anything contained herein or otherwise, no refunds of premium shall be made in respect of the

Insured Person where any claim has been admitted by Us or has been lodged with Us or any Benefit has been

availed by the Insured Person under the Policy.

d) Cancellation of Policy Certificate:

The Insured Person may cancel the cover under the Policy by giving 15 days prior written notice in writing to Us.

We shall from the date of receipt of notice cancel the Insured Person’s cover under the Policy and refund the

premium for the period the cover under the Policy has been in force as per the refund grid applicable. The

Insured Person is not permitted to cancel only a portion of the Benefits available. If opting for cancelation, all

Benefits under the Policy will be cancelled.

10. Scope of Cover

The Scope of Cover shall be worldwide unless specified otherwise in the Policy Certificate

11. Policy Disputes

Any dispute concerning the interpretation of the terms, conditions, limitations and/or exclusions contained herein

shall be adjudicated or interpreted in accordance with Indian Laws and only competent Indian courts shall have

the exclusive jurisdiction to try all or any matters arising hereunder. The matter shall be determined or

adjudicated in accordance with the law and practice of such Court.

12. Notices

Any notice, direction or instruction given under this Policy shall be in writing and delivered by hand, post, or

facsimile to: In case of the Insured Person, at the address specified in the Policy Certificate.

In case of Us:

ICICI Lombard General Insurance Company Limited, ICICI Lombard House,


56

414, Veer Savarkar Marg, Near Siddhi Vinayak Temple,

Prabhadevi, Mumbai 400 025

Notice and instructions will be deemed served 7 days after posting or immediately upon receipt in the case of

hand delivery, facsimile or e-mail.

13. Customer Service

If at any time the Insured Person (or his Nominee/ legal heir, as the case may be) requires any clarification or

assistance, they may contact Our offices at the address specified below, during normal business hours.

ICICI Lombard General Insurance Company Limited

ICICI Lombard House 414, Veer Savarkar Marg,

Siddhi Vinayak Temple, Prabhadevi, Mumbai 400025.

14. Grievances

In case You are aggrieved in any way, You should do the following:

1. Call Us at toll free number: 1800 2666 or email us at [email protected]

2. If You are not satisfied with the resolution then You may successively write to The Manager - Service Quality,

at the following address:

ICICI Lombard General Insurance Company Limited

ICICI Lombard House 414, Veer Savarkar Marg,

Siddhi Vinayak Temple, Prabhadevi, Mumbai 400025.

3. If you are not satisfied with the resolution provided, you may approach us at the section “Grievance Redressal”

on our website www. icicilombard.com (Customer Support section).

4. If You are not satisfied with Our response or do not receive a response from Us within 15 days, You may

approach the Grievance Cell of the Authority at:

Insurance Regulatory and Development Authority of India;

Grievance Call Centre (IGCC) Toll Free No:155255 Email ID: [email protected].

You can also register Your complaint online at http://www.igms.irda.gov.in

You can also register Your complaint through fax/letter by submitting Your complaint to:

Consumer Affairs Department Insurance Regulatory and Development Authority of India ; 9th floor,

United India Towers, Basheerbagh; Hyderabad – 500 029, Telangana; Fax No: 91- 40 – 6678 9768.

If the issue still remains unresolved, You may, subject to vested jurisdiction, approach Insurance Ombudsman

for the redressal of the grievance.

The details of Insurance Ombudsman are available below:


57

Office Details Jurisdiction of Office

Union Territory, District

AHMEDABAD - Shri Kuldip Singh Gujarat,

Office of the Insurance Ombudsman, Dadra & Nagar Haveli,

Jeevan Prakash Building, 6th floor, Daman and Diu.

Tilak Marg, Relief Road,

Ahmedabad – 380 001.

Tel.: 079 - 25501201/02/05/06

Email: [email protected]

BENGALURU - Smt. Neerja Shah Karnataka.

Office of the Insurance Ombudsman,

Jeevan Soudha Building,PID No. 57-27-N-19

Ground Floor, 19/19, 24th Main Road,

JP Nagar, Ist Phase,

Bengaluru – 560 078.

Tel.: 080 - 26652048 / 26652049


BHOPAL - Shri Guru Saran Shrivastava Madhya Pradesh

Office of the Insurance Ombudsman, Chattisgarh.

Janak Vihar Complex, 2nd Floor,

6, Malviya Nagar, Opp. Airtel Office,

Near New Market,

Bhopal – 462 003.

Tel.: 0755 - 2769201 / 2769202

Fax: 0755 - 2769203




58


BHUBANESHWAR - Shri Suresh Chandra

Panda

Orissa.


62, Forest park,

Bhubneshwar – 751 009.

Tel.: 0674 - 2596461 /2596455

Fax: 0674 - 2596429


CHANDIGARH - Dr. Dinesh Kumar Verma Punjab,

Office of the Insurance Ombudsman, Haryana,

S.C.O. No. 101, 102 & 103, 2nd Floor, Himachal Pradesh,

Batra Building, Sector 17 – D, Jammu & Kashmir,

Chandigarh – 160 017. Chandigarh.

Tel.: 0172 - 2706196 / 2706468

Fax: 0172 - 2708274


CHENNAI - Shri M. Vasantha Krishna Tamil Nadu,

Office of the Insurance Ombudsman, Pondicherry Town and

Fatima Akhtar Court, 4th Floor, 453, Karaikal (which are part of

Pondicherry).

Anna Salai, Teynampet,

CHENNAI – 600 018.

Tel.: 044 - 24333668 / 24335284

Fax: 044 - 24333664


DELHI - Shri Sudhir Krishna Delhi.






59


2/2 A, Universal Insurance Building,

Asaf Ali Road,

New Delhi – 110 002.

Tel.: 011 - 23232481/23213504


GUWAHATI - Shri Kiriti .B. Saha Assam,

Office of the Insurance Ombudsman, Meghalaya,

Jeevan Nivesh, 5th Floor, Manipur,

Nr. Panbazar over bridge, S.S. Road, Mizoram,

Guwahati – 781001(ASSAM). Arunachal Pradesh,

Tel.: 0361 - 2632204 / 2602205 Nagaland and Tripura.


HYDERABAD - Shri I. Suresh Babu Andhra Pradesh,

Office of the Insurance Ombudsman, Telangana,

6-2-46, 1st floor, "Moin Court", Yanam and

Lane Opp. Saleem Function Palace, part of Territory of Pondicherry.

A. C. Guards, Lakdi-Ka-Pool,

Hyderabad - 500 004.

Tel.: 040 - 67504123 / 23312122

Fax: 040 - 23376599


JAIPUR - Smt. Sandhya Baliga Rajasthan.


Jeevan Nidhi – II Bldg., Gr. Floor,

Bhawani Singh Marg,





60

Jaipur - 302 005.

Tel.: 0141 - 2740363


ERNAKULAM - Ms. Poonam Bodra Kerala,

Office of the Insurance Ombudsman, Lakshadweep,

2nd Floor, Pulinat Bldg., Mahe-a part of Pondicherry.

Opp. Cochin Shipyard, M. G. Road,

Ernakulam - 682 015.

Tel.: 0484 - 2358759 / 2359338

Fax: 0484 - 2359336


KOLKATA - Shri P. K. Rath West Bengal,

Office of the Insurance Ombudsman, Sikkim,

Hindustan Bldg. Annexe, 4th Floor, Andaman & Nicobar Islands.

4, C.R. Avenue,

KOLKATA - 700 072.

Tel.: 033 - 22124339 / 22124340

Fax : 033 - 22124341


LUCKNOW -Shri Justice Anil Kumar

Srivastava

Districts of Uttar Pradesh :

Office of the Insurance Ombudsman, Laitpur, Jhansi, Mahoba, Hamirpur,

Banda, Chitrakoot, Allahabad,

Mirzapur, Sonbhabdra, Fatehpur,

Pratapgarh, Jaunpur,Varanasi,

Gazipur, Jalaun, Kanpur, Lucknow,

Unnao, Sitapur, Lakhimpur, Bahraich,

Barabanki, Raebareli, Sravasti,

Gonda, Faizabad, Amethi,





61

Kaushambi, Balrampur, Basti,

Ambedkarnagar, Sultanpur,

Maharajgang, Santkabirnagar,

Azamgarh, Kushinagar, Gorkhpur,

Deoria, Mau, Ghazipur, Chandauli,

Ballia, Sidharathnagar.

6th Floor, Jeevan Bhawan, Phase-II,

Nawal Kishore Road, Hazratganj,

Lucknow - 226 001.

Tel.: 0522 - 2231330 / 2231331

Fax: 0522 - 2231310


MUMBAI - Shri Milind A. Kharat Goa,

Office of the Insurance Ombudsman, Mumbai Metropolitan Region

3rd Floor, Jeevan Seva Annexe, excluding Navi Mumbai & Thane.

S. V. Road, Santacruz (W),

Mumbai - 400 054.

Tel.: 022 - 26106552 / 26106960

Fax: 022 - 26106052


NOIDA - Shri Chandra Shekhar Prasad State of Uttaranchal and the following

Districts of Uttar Pradesh:

Office of the Insurance Ombudsman, Agra, Aligarh, Bagpat, Bareilly,

Bijnor, Budaun, Bulandshehar, Etah,

Kanooj, Mainpuri, Mathura, Meerut,

Moradabad, Muzaffarnagar, Oraiyya,

Pilibhit, Etawah, Farrukhabad,

Firozbad, Gautambodhanagar,

Ghaziabad, Hardoi, Shahjahanpur,

Hapur, Shamli, Rampur, Kashganj,

Sambhal, Amroha, Hathras,

Kanshiramnagar, Saharanpur.




62

Bhagwan Sahai Palace

4th Floor, Main Road,

Naya Bans, Sector 15,

Distt: Gautam Buddh Nagar,

U.P-201301.

Tel.: 0120-2514250 / 2514252 / 2514253


PATNA - Shri N. K. Singh Bihar,

Office of the Insurance Ombudsman, Jharkhand.

1st Floor,Kalpana Arcade Building,,

Bazar Samiti Road,

Bahadurpur,

Patna 800 006.

Tel.: 0612-2680952


PUNE - Shri Vinay Sah Maharashtra,

Office of the Insurance Ombudsman, Area of Navi Mumbai and Thane

Jeevan Darshan Bldg., 3rd Floor, excluding Mumbai Metropolitan

Region.

C.T.S. No.s. 195 to 198,

N.C. Kelkar Road, Narayan Peth,

Pune – 411 030.

Tel.: 020-41312555


The updated details of Insurance Ombudsman are also available on IRDA website: www.irdaindia.org, on the

website of General Insurance Council: www. g e n e r a l i n s u r a n c e c o u n c i l . o r g . i n , w e b s i t e o f

t h e c o m p a n y www.icicilombard.com or from any of the offices of the Company.


mailto:[email protected]%20.



63

ENDORSEMENTS AVAILABLE UNDER THIS POLICY

Endorsement I: Periodical Claim Payment Clause

We will pay the claim amount for the Payout Period by way of periodical installments as per the Periodicity opted

by the Insured Person (or his Nominee/ legal heir, as the case may be) for a given period as specified in the

Policy Certificate.

We shall be liable to pay only for the amount and period specified in the Policy Certificate.

“Payout Period” and “Periodicity” means the period and payout frequency respective, as specified in the Policy

Certificate for which the periodical benefit shall be paid.

Endorsement II: Premium Installment Clause

a. We will accept payment of the premium applicable taxes, charges, cess etc. in monthly/quarterly/semi-

annual/annual installments as specified in the Policy Certificate provided that the Policyholder continues

to perform and observe all their obligations hereunder.

b. Notwithstanding the above Clause, upon non-payment of any premium installments for up to 7 days from

the due date of such installment thereof, this Policy shall cease to operate from the time and date of the

default in payment of such premium installment and We shall not be liable under this Policy for any loss

occurring thereafter, nor shall any refund of premium become due under the Policy. We shall not be

bound to give any notice that such Premium Installment is due.

c. However if the Policyholder makes the payment of the due installment before the payment of next

installment due date or the Policy End Date as specified in the Policy Certificate, whichever is earlier,

and further provided that all the other installments payable under the Policy are realized by the Company

by the respective due dates, the Company may at its sole option revive the Policy, subject to the balance

Sum Insured(s) if any, of the respective Section(s)/Benefits(s) at the time of such revival.

d. Notwithstanding anything to the contrary contained above, in the event of a claim becoming payable

under the Policy all the subsequent premium installments shall immediately become due and payable.

We shall not be obligated to give any notice to the Policyholder for payment of premium installment, and

may recover and deduct any or all the pending premium installments from the claim amount falling due

under the Policy.

Endorsement III: Auto Renewal Clause

a. We will automatically renew the Policy for the Policy Period as opted by the policyholder. However, after

completing its entire auto Renewal period on expiry of the Policy on the Policy End Date, We shall not

be bound to accept any Renewal premium nor give notice that such Renewal premium is due.

b. Every Renewal premium shall be paid and accepted as per the terms of Renewal specified under this

Policy and upon the distinct understanding that no alteration has taken place in the facts contained in

the Proposal and Declaration Form herein before mentioned and that nothing is known to the Insured

Person that may result to enhance the risk of We under the guarantee hereby given. Any change in the

risk will be intimated to the Company by the Policyholder/ Insured Person. Nothing herein or otherwise


64

shall affect Our right to impose any additional terms and conditions on Renewal or restrict any Renewal

terms as to premium or otherwise.

c. No Renewal receipt shall be valid unless it is on the printed form of Our and signed by Our authorized

official.